MEDICARE: RICHARD J NORMAN DPM

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	213E00000X	Podiatrist	E4306	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7830250	OTHER	CA	AETNA PIN
2	00E43060	OTHER	CA	BLUE SHIELD PIN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	E4306	OTHER	CA	BLUE CROSS

General Provider Information

NPI Number	:	1831119718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD J NORMAN DPM

Provider Business Mailing Address
First Line	:	2 JAMES WAY
Second Line	:	STE. 205
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-4973
Country	:	US
Telephone Number	:	805-773-3668
Fax Number	:	805-773-1043

Provider Business Practice Location Address
First Line	:	2 JAMES WAY
Second Line	:	STE. 205
City	:	PISMO BEACH
State	:	CA
Zip	:	93449-4973
Country	:	US
Telephone Number	:	805-773-3668
Fax Number	:	805-773-1043

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	05/25/2011

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