MEDICARE: DR. TERESA GAIL NORMAN M.D.

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
1	207Q00000X	Family Medicine Physician	ME49384	FL

General Provider Information

NPI Number	:	1750464236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESA GAIL NORMAN M.D.

Provider Business Mailing Address
First Line	:	4907 LONDONDERRY DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-1333
Country	:	US
Telephone Number	:	813-728-5157
Fax Number	:	813-979-9526

Provider Business Practice Location Address
First Line	:	4907 LONDONDERRY DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-1333
Country	:	US
Telephone Number	:	813-728-5157
Fax Number	:	813-979-9526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/08/2007

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