Healthcare Provider Details

I. General information

NPI: 1841276102
Provider Name (Legal Business Name): KENNETH JEWELL NORRIS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W NORTHERN LIGHTS BLVD STE B
ANCHORAGE AK
99503-3652
US

IV. Provider business mailing address

PO BOX 2908
PORTLAND OR
97208-2908
US

V. Phone/Fax

Practice location:
  • Phone: 907-212-5165
  • Fax: 907-212-0950
Mailing address:
  • Phone: 425-207-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD071034L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5912
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: