Basic Information
| Provider Information | |||||||||
| NPI: | 1811091366 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | NOBLE | ||||||||
| MiddleName: | ERIC | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 CHANNEL DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | JUNEAU | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998017837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074634040 | ||||||||
| FaxNumber: | 9073641539 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 SALMON CREEK LANE | ||||||||
| Address2: | SEARHC ETHEL LUND MEDICAL CENTER | ||||||||
| City: | HAINES | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074634040 | ||||||||
| FaxNumber: | 9073641539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2006 | ||||||||
| LastUpdateDate: | 10/21/2015 | ||||||||
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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 | 207Q00000X | 5316 | AK | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0101235379 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | A88536 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD00044339 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 13647 | HI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD423174 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | MD53163 | 05 | AK | MEDICAID |