Healthcare Provider Details

I. General information

NPI: 1356347975
Provider Name (Legal Business Name): HOWARD G NORMAN, DO LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N CENTRAL AVE
AVONDALE AZ
85323-1906
US

IV. Provider business mailing address

425 N CENTRAL AVE
AVONDALE AZ
85323-1906
US

V. Phone/Fax

Practice location:
  • Phone: 623-932-1211
  • Fax: 623-932-3674
Mailing address:
  • Phone: 623-932-1211
  • Fax: 623-932-3674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0970
License Number StateAZ

VIII. Authorized Official

Name: MR. HOWARD G NORMAN
Title or Position: PRESIDENT
Credential: DO
Phone: 623-932-1211