MEDICARE: NORMAN ERVIN M. D.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51097556	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1821089012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NORMAN ERVIN M. D.

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	:	256-533-4212

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	:	256-533-4212

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

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	01/19/2010

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Directions to “ NORMAN ERVIN M. D.” Practice Location

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