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NPI Code Detail

MEDICARE: DR. JAMES RUSSEL VAN NORMAN MD

MEDICARE: DR. JAMES RUSSEL VAN NORMAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianH4763TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043316508
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES RUSSEL VAN NORMAN MD
Provider Business Mailing Address
First Line : PO BOX 3548
Second Line :
City : AUSTIN
State : TX
Zip : 78764-3548
Country : US
Telephone Number : 512-472-4357
Fax Number : 512-703-1394
Provider Business Practice Location Address
First Line : 1430 COLLIER ST
Second Line :
City : AUSTIN
State : TX
Zip : 78704-2911
Country : US
Telephone Number : 512-472-4357
Fax Number : 512-703-1394
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2006
Last Update Date : 04/24/2012

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