Provider Demographics
NPI:1427020890
Name:NORRIS, KYLE F (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:F
Last Name:NORRIS
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 1:1119 N AZTEC ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1567
Mailing Address - Country:US
Mailing Address - Phone:928-774-7757
Mailing Address - Fax:
Practice Address - Street 1:1485 N TURQUOISE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1398
Practice Address - Country:US
Practice Address - Phone:928-774-7757
Practice Address - Fax:928-774-7767
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30444174400000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF83290Medicare UPIN
AZZ70576Medicare ID - Type Unspecified