Provider Demographics
NPI:1316147713
Name:DONALD R NOEL, PA
Entity type:Organization
Organization Name:DONALD R NOEL, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-253-3268
Mailing Address - Street 1:10101 SE MAIN ST STE 3008
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2458
Mailing Address - Country:US
Mailing Address - Phone:503-253-3268
Mailing Address - Fax:503-253-1530
Practice Address - Street 1:10101 SE MAIN ST STE 3008
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2458
Practice Address - Country:US
Practice Address - Phone:503-253-3268
Practice Address - Fax:503-253-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00235363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR4884260001OtherMEDICARE DMERC
ORR01271Medicare UPIN
OR097BKMBXMedicare PIN