Provider Demographics
NPI:1841490109
Name:NOLL, DAVID ALAN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:NOLL
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 1:6420 PROSPECT AVE
Mailing Address - Street 2:T-207
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-4147
Mailing Address - Country:US
Mailing Address - Phone:816-276-9100
Mailing Address - Fax:816-276-9101
Practice Address - Street 1:6420 PROSPECT AVE
Practice Address - Street 2:T-207
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-4147
Practice Address - Country:US
Practice Address - Phone:816-276-9100
Practice Address - Fax:816-276-9101
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007022064207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100452440BMedicaid
MO1063468361Medicaid
MO207323106Medicaid
MOP00709716Medicare PIN
MO1063468361Medicaid
MO207323106Medicaid
KS100452440BMedicaid
MOT41000002Medicare PIN