Individual
ELISABETH L NOELKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, PA
Contact information
Practice address
3501 KNICKERBOCKER RD, SAN ANGELO, TX 76904-7610
(325) 947-6960
(800) 809-9641
Mailing address
223 S ABE ST, SAN ANGELO, TX 76903-6305
(325) 212-9236
(800) 809-9641
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
J0164
TX
208000000X
Pediatrics Physician
J0164
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111604802
—
TX
01
—
8F22613
MEDICARE PTAN RENDERING NPI
TX
Enumeration date
11/07/2006
Last updated
01/27/2019
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