Provider Demographics
NPI:1396184420
Name:NORRIS, NATHAN BLAKE (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:BLAKE
Last Name:NORRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5501 NW 62ND TER STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2412
Mailing Address - Country:US
Mailing Address - Phone:816-842-4440
Mailing Address - Fax:816-843-1974
Practice Address - Street 1:1133 W KANSAS ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-2281
Practice Address - Country:US
Practice Address - Phone:816-781-7400
Practice Address - Fax:816-781-3315
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-38701207Q00000X
OK35371207Q00000X
MO2015014717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine