Provider Demographics
NPI:1033112909
Name:NOONAN, TROY P (MD)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:P
Last Name:NOONAN
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 1:710 OAKFIELD DR
Mailing Address - Street 2:STE 261
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4937
Mailing Address - Country:US
Mailing Address - Phone:813-657-7022
Mailing Address - Fax:813-657-1049
Practice Address - Street 1:710 OAKFIELD DR
Practice Address - Street 2:STE 261
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4937
Practice Address - Country:US
Practice Address - Phone:813-657-7022
Practice Address - Fax:813-657-1049
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
FLME0074311174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2783CMedicare ID - Type Unspecified
FLG98810Medicare UPIN