Healthcare Provider Details

I. General information

NPI: 1831820596
Provider Name (Legal Business Name): ROGER K NORTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W KENWOOD AVE STE 100
DECATUR IL
62526-4379
US

IV. Provider business mailing address

PO BOX 19639
SPRINGFIELD IL
62794-9639
US

V. Phone/Fax

Practice location:
  • Phone: 217-872-3800
  • Fax: 217-872-0849
Mailing address:
  • Phone: 217-545-8000
  • Fax: 544-470-2486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125080705
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036.175893
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: