Provider Demographics
NPI:1205824638
Name:TOM R NORRIS M D A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:TOM R NORRIS M D A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-392-3225
Mailing Address - Street 1:2351 CLAY ST
Mailing Address - Street 2:STE 510
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1931
Mailing Address - Country:US
Mailing Address - Phone:415-392-3225
Mailing Address - Fax:415-928-1035
Practice Address - Street 1:2351 CLAY ST
Practice Address - Street 2:STE 510
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1931
Practice Address - Country:US
Practice Address - Phone:415-392-3225
Practice Address - Fax:415-928-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG215690207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG21569OtherLICENSE NUMER
A41315Medicare UPIN
CAAR066Medicare PIN