MEDICARE: NORMAN D. ERVIN, M.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	10392	AL

General Provider Information

NPI Number	:	1053637348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORMAN D. ERVIN, M.D., P.C.

Provider Business Mailing Address
First Line	:	101 BOB WALLACE AVE SW
Second Line	:	SUITE B
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-3847
Country	:	US
Telephone Number	:	256-533-2303
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 BOB WALLACE AVE SW
Second Line	:	SUITE B
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-3847
Country	:	US
Telephone Number	:	256-533-2303
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NORMAN DUANE ERVIN
Credential	:	M.D.
Telephone Number	:	256-533-2303

Provider Enumeration Date	:	04/13/2010
Last Update Date	:	04/13/2010

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