Provider Demographics
NPI:1407168610
Name:NORMAN, ROBERT JAMES (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:NORMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 S CROWN HILL RD
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-9527
Mailing Address - Country:US
Mailing Address - Phone:330-682-3075
Mailing Address - Fax:330-682-7454
Practice Address - Street 1:365 S CROWN HILL RD
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-9527
Practice Address - Country:US
Practice Address - Phone:330-682-3075
Practice Address - Fax:330-682-7454
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34010403207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0064410Medicaid
H071400Medicare PIN