Healthcare Provider Details

I. General information

NPI: 1255448114
Provider Name (Legal Business Name): RICHARD WILLIAM NORLIN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 WATSON RD SUITE 1B
SAINT LOUIS MO
63126-1854
US

IV. Provider business mailing address

4424 LACLEDE AVE
SAINT LOUIS MO
63108-2204
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-1900
  • Fax: 314-821-6001
Mailing address:
  • Phone: 314-821-1900
  • Fax: 314-821-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000574
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: