Provider Demographics
NPI:1023061264
Name:NOBLES, BENNIE PETER JR (MD)
Entity type:Individual
Prefix:
First Name:BENNIE
Middle Name:PETER
Last Name:NOBLES
Suffix:JR
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 1:4228 HOUMA BLVD
Mailing Address - Street 2:STE 410
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-3021
Mailing Address - Country:US
Mailing Address - Phone:504-883-3770
Mailing Address - Fax:504-883-3711
Practice Address - Street 1:4228 HOUMA BLVD
Practice Address - Street 2:STE 410
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-3021
Practice Address - Country:US
Practice Address - Phone:504-883-3770
Practice Address - Fax:504-883-3711
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD011582207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1149543Medicaid
D04243Medicare UPIN
LA1149543Medicaid
LA5DH66Medicare PIN
LA5DH66Medicare PIN