MEDICARE: DR. ROBERT MITCHELL NORMAN MD

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	2084P0800X	Psychiatry Physician	M5857	TX
2	2084P0800X	Psychiatry Physician	162599	CA
3	2084P0800X	Psychiatry Physician	036150134	IL

General Provider Information

NPI Number	:	1558579755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT MITCHELL NORMAN MD

Provider Business Mailing Address
First Line	:	1213 WATERS DAIRY RD APT 103
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76502-3426
Country	:	US
Telephone Number	:	972-898-1478
Fax Number	:

Provider Business Practice Location Address
First Line	:	444 N PLEASANT AVE
Second Line	:
City	:	CENTRALIA
State	:	IL
Zip	:	62801-3006
Country	:	US
Telephone Number	:	618-436-5665
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2007
Last Update Date	:	11/10/2020

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