Healthcare Provider Details

I. General information

NPI: 1902001621
Provider Name (Legal Business Name): BARRY D NORRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 PARK AVE
SOQUEL CA
95073-2833
US

IV. Provider business mailing address

2930 PARK AVE
SOQUEL CA
95073-2833
US

V. Phone/Fax

Practice location:
  • Phone: 831-475-7400
  • Fax: 831-477-2081
Mailing address:
  • Phone: 831-475-7400
  • Fax: 831-477-2081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberG42711
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG42711
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: