Basic Information
| Provider Information | |||||||||
| NPI: | 1811045289 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOONAN | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 FANNIN ST STE 1700 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134867500 | ||||||||
| FaxNumber: | 7135122234 | ||||||||
| Practice Location | |||||||||
| Address1: | 23923 CINCO RANCH BLVD | ||||||||
| Address2: | |||||||||
| City: | KATY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774943399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134867575 | ||||||||
| FaxNumber: | 2817699942 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 10/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | L8867 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8DZ427 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 194880402 | 05 | TX | MEDICAID |