Provider Demographics
NPI:1811099609
Name:NOORDA, JAMESON B (DPM)
Entity type:Individual
Prefix:DR
First Name:JAMESON
Middle Name:B
Last Name:NOORDA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 N PECOS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7339
Mailing Address - Country:US
Mailing Address - Phone:702-456-1441
Mailing Address - Fax:702-456-3901
Practice Address - Street 1:68 N PECOS RD
Practice Address - Street 2:SUITE A
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7339
Practice Address - Country:US
Practice Address - Phone:702-456-1441
Practice Address - Fax:702-456-3901
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0505213E00000X, 213ES0103X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
V08961Medicare UPIN
V08961Medicare UPIN