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NPI Code Detail

MEDICARE: MR. JEFFREY TODD NORRIS PA

MEDICARE: MR. JEFFREY TODD NORRIS PA
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
1363A00000XPhysician AssistantPA326AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
251512732OTHERALBXBS

General Provider Information

NPI Number : 1902801517
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEFFREY TODD NORRIS PA
Provider Business Mailing Address
First Line : PO BOX 6599
Second Line :
City : DOTHAN
State : AL
Zip : 36302-6599
Country : US
Telephone Number : 334-944-7073
Fax Number :
Provider Business Practice Location Address
First Line : 4300 W MAIN ST STE 405
Second Line :
City : DOTHAN
State : AL
Zip : 36305-1086
Country : US
Telephone Number : 334-944-7073
Fax Number : 334-793-5346
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2005
Last Update Date : 03/04/2021

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