Provider Demographics
NPI:1447303706
Name:NOBLE, MARY M (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:NOBLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W 5TH AVE STE 200W
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-4803
Mailing Address - Country:US
Mailing Address - Phone:509-744-3750
Mailing Address - Fax:509-744-3969
Practice Address - Street 1:104 W 5TH AVE STE 200W
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-4803
Practice Address - Country:US
Practice Address - Phone:509-744-3750
Practice Address - Fax:509-744-3969
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017214207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1622208Medicaid
WAP00119334Medicare PIN
WAGAB32524Medicare PIN
WAA07915Medicare UPIN
WAP00132629Medicare PIN
WA110240798Medicare PIN