Provider Demographics
NPI:1902124472
Name:NOONAN, BRUCE DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DOUGLAS
Last Name:NOONAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4727 BLUFF DR NE
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-9075
Mailing Address - Country:US
Mailing Address - Phone:509-766-6335
Mailing Address - Fax:509-766-6335
Practice Address - Street 1:4727 BLUFF DR NE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-9075
Practice Address - Country:US
Practice Address - Phone:509-766-6335
Practice Address - Fax:509-766-6335
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-08
Last Update Date:2010-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00012647207W00000X
OR8830207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology