Healthcare Provider Details

I. General information

NPI: 1841267747
Provider Name (Legal Business Name): THADDEUS MICHAEL NORRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W 35TH ST
GARDEN CITY ID
83714-6520
US

IV. Provider business mailing address

2000 S MYERS ST
BOISE ID
83706-4008
US

V. Phone/Fax

Practice location:
  • Phone: 503-704-2415
  • Fax:
Mailing address:
  • Phone: 503-704-1415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMV-0023
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: