1013131887 NPI number — DR. GARY WINSTON NOBLE M.D.

Table of content: DR. GARY WINSTON NOBLE M.D. (NPI 1013131887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013131887 NPI number — DR. GARY WINSTON NOBLE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOBLE
Provider First Name:
GARY
Provider Middle Name:
WINSTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013131887
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34 WRIGHTS POINT CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAUFORT
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29902-6955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-522-2988
Provider Business Mailing Address Fax Number:
843-524-1879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 RIBAUT RD
Provider Second Line Business Practice Location Address:
COASTAL EMPIRE MENTAL HEALTH
Provider Business Practice Location Address City Name:
BEAUFORT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29902-5400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-524-3378
Provider Business Practice Location Address Fax Number:
843-524-1879
Provider Enumeration Date:
04/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  27428 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0805X , with the licence number: 56331 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)