Healthcare Provider Details

I. General information

NPI: 1407168610
Provider Name (Legal Business Name): ROBERT JAMES NORMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 S CROWN HILL RD
ORRVILLE OH
44667-9527
US

IV. Provider business mailing address

365 S CROWN HILL RD
ORRVILLE OH
44667-9527
US

V. Phone/Fax

Practice location:
  • Phone: 330-682-3075
  • Fax: 330-682-7454
Mailing address:
  • Phone: 330-682-3075
  • Fax: 330-682-7454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34010403
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: