F. Richard Noodleman MD a Professional Corporation

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

G422290 Issued in CA

Legal business name

F. RICHARD NOODLEMAN MD A PROFESSIONAL CORPORATION

Doing business as

Age Defy Dermatology and Wellness Incorporated

Practice address

3803 S Bascom Ave
Suite 200
Campbell, CA 95008-7317

Phone

(408) 559-0988

Fax

(408) 369-4263

NPI assigned

Sep 11, 2007

Last updated

Oct 24, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Frank Richard Noodleman, MD

Title

Medical Director

Phone

(408) 559-0988

Specialties & licenses 1

Addresses

Other names 1

• Age Defy Dermatology and Wellness Incorporated Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193184000000",
    "number": "1710172994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3803 S BASCOM AVE",
            "address_2": "SUITE 200",
            "city": "CAMPBELL",
            "state": "CA",
            "postal_code": "950087317",
            "telephone_number": "408-559-0988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3803 S BASCOM AVE",
            "address_2": "SUITE 200",
            "city": "CAMPBELL",
            "state": "CA",
            "postal_code": "950087317",
            "telephone_number": "408-559-0988",
            "fax_number": "408-369-4263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "F. RICHARD NOODLEMAN MD A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-11",
        "last_updated": "2007-10-24",
        "status": "A",
        "authorized_official_last_name": "NOODLEMAN",
        "authorized_official_first_name": "FRANK",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "408-559-0988",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "G422290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Age Defy Dermatology and Wellness Incorporated",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Procedural Dermatology Physician in Campbell, CA
• Providers in Campbell, CA by specialty
• Procedural Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.