Healthcare Provider Details

I. General information

NPI: 1669864500
Provider Name (Legal Business Name): ADAM NORGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BAYLOR PLZ MS:BCM115
HOUSTON TX
77030-3411
US

IV. Provider business mailing address

7675 PHOENIX DR APT 720
HOUSTON TX
77030-4713
US

V. Phone/Fax

Practice location:
  • Phone: 713-798-8650
  • Fax:
Mailing address:
  • Phone: 210-643-8649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP127274
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: