Healthcare Provider Details

I. General information

NPI: 1710284062
Provider Name (Legal Business Name): JACK D. NORMAN, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 BRICKELL AVE SUITE #820
MIAMI FL
33131-2949
US

IV. Provider business mailing address

848 BRICKELL AVE SUITE #820
MIAMI FL
33131-2949
US

V. Phone/Fax

Practice location:
  • Phone: 305-358-7110
  • Fax: 305-379-6777
Mailing address:
  • Phone: 305-358-7110
  • Fax: 305-379-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JACK D NORMAN
Title or Position: OWNER
Credential: M.D.
Phone: 305-667-1224