Provider Demographics
NPI:1811132152
Name:PAGE, PAUL NOBLE (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:NOBLE
Last Name:PAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 756
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-0756
Mailing Address - Country:US
Mailing Address - Phone:877-866-0914
Mailing Address - Fax:
Practice Address - Street 1:8100 BRUCEVILLE RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823
Practice Address - Country:US
Practice Address - Phone:916-683-9616
Practice Address - Fax:916-688-1320
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD2040572085R0001X
CAA991542085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02777031Medicaid
CA1811132152Medicaid
LA2124871Medicaid
LA363608YH3UMedicare PIN