Healthcare Provider Details

I. General information

NPI: 1194024935
Provider Name (Legal Business Name): JOHN LAWRENCE NORRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 OLIVET RD
SANTA ROSA CA
95401-3810
US

IV. Provider business mailing address

1415 OLIVET RD
SANTA ROSA CA
95401-3810
US

V. Phone/Fax

Practice location:
  • Phone: 707-540-0929
  • Fax:
Mailing address:
  • Phone: 707-540-0929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberCO32402
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberC032402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: