Provider Demographics
NPI:1124107792
Name:NOYES, ROBERT DIRK (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DIRK
Last Name:NOYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:R
Other - Middle Name:DIRK
Other - Last Name:NOYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5169 COTTONWOOD ST
Mailing Address - Street 2:#440
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6767
Mailing Address - Country:US
Mailing Address - Phone:801-507-3915
Mailing Address - Fax:801-507-3916
Practice Address - Street 1:5169 COTTONWOOD ST
Practice Address - Street 2:#440
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6767
Practice Address - Country:US
Practice Address - Phone:801-507-3915
Practice Address - Fax:801-507-3916
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT15771212052086X0206X
UT157712-1205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT942854057089Medicaid
UT942854057089Medicaid
UT000059891Medicare PIN
UTD26485Medicare UPIN