Provider Demographics
NPI:1811091366
Name:ANDERSON, NOBLE ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:NOBLE
Middle Name:ERIC
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3100 CHANNEL DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7837
Mailing Address - Country:US
Mailing Address - Phone:907-463-4040
Mailing Address - Fax:907-364-1539
Practice Address - Street 1:1200 SALMON CREEK LANE
Practice Address - Street 2:SEARHC ETHEL LUND MEDICAL CENTER
Practice Address - City:HAINES
Practice Address - State:AK
Practice Address - Zip Code:99801
Practice Address - Country:US
Practice Address - Phone:907-463-4040
Practice Address - Fax:907-364-1539
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2015-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK5316207Q00000X
VA0101235379207Q00000X
CAA88536207Q00000X
WAMD00044339207Q00000X
HI13647207Q00000X
PAMD423174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD53163Medicaid
AKMD53163Medicaid
AK8ED281Medicare PIN
AK8ED279Medicare PIN
AK8ED280Medicare PIN
AK8ED282Medicare PIN
AK8ED898Medicare PIN
AK8ED278Medicare PIN