Provider Demographics
NPI:1275509028
Name:NORRIS, RUSSELL LEROY III (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:LEROY
Last Name:NORRIS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 CANNERY CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1018
Mailing Address - Country:US
Mailing Address - Phone:813-349-5002
Mailing Address - Fax:
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD
Practice Address - Street 2:DEPT 123
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-978-5946
Practice Address - Fax:813-978-5996
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55546207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14812OtherFL BCBS
FLP00215747OtherMEDICARE RAILROAD
FL14812UMedicare ID - Type UnspecifiedFGTBA M/CARE PROVIDER #
FL14812WMedicare ID - Type Unspecified
FL14812OtherFL BCBS
FLF23468Medicare UPIN