Healthcare Provider Details

I. General information

NPI: 1003883547
Provider Name (Legal Business Name): DAVID PATRICK NORRIS IDC, BSHS,MSHS,USN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 USS JAMES MADISON RD NAVAL BRANCH HEALTH CLINIC
CPU KINGS BAY GA
31547-2531
US

IV. Provider business mailing address

100 TARPON PL
SAINT MARYS GA
31558-3630
US

V. Phone/Fax

Practice location:
  • Phone: 912-573-2410
  • Fax:
Mailing address:
  • Phone: 912-882-2361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: