Provider Demographics
NPI:1396849998
Name:NORMAN, BRUCE ELLIOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ELLIOTT
Last Name:NORMAN
Suffix:
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 1:111 N BLOODWORTH ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601-1103
Mailing Address - Country:US
Mailing Address - Phone:919-833-2836
Mailing Address - Fax:919-785-0523
Practice Address - Street 1:111 N BLOODWORTH ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-1103
Practice Address - Country:US
Practice Address - Phone:919-833-2836
Practice Address - Fax:919-785-0523
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040176207VG0400X
NC9501030207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H08317Medicare UPIN