Provider Demographics
NPI:1790962082
Name:SUENO-NOEL, DEREK THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:THOMAS
Last Name:SUENO-NOEL
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:MEDDAC-BAVARIA
Mailing Address - Street 2:PSC 411 UNIT 28037
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112
Mailing Address - Country:US
Mailing Address - Phone:314-590-2986
Mailing Address - Fax:
Practice Address - Street 1:MEDDAC-BAVARIA
Practice Address - Street 2:PSC 411 UNIT 28037
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112
Practice Address - Country:US
Practice Address - Phone:314-590-2986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT051573207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine