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General NPI Number Information
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NPI Number | 1104575273
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Entity Type | Individual
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Provider Name | JUSTIN MARSHALL NORRIS D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/23/2022
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 14000 FIVAY RD
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City | HUDSON
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State | FL
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Zip | 34667-7103
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Country | US
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Telephone | 727-819-2966
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Fax | 727-819-2928
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Provider Business Mailing Address
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Address Line | 3229 W BARTLETT PL
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City | TUCSON
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State | AZ
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Zip | 85741-3655
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Country | US
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Telephone | 720-467-0389
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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