Provider Demographics
NPI:1447211321
Name:NORRIS, RANDALL GENE (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:GENE
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 1:1900 SAINT CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546
Mailing Address - Country:US
Mailing Address - Phone:812-634-1211
Mailing Address - Fax:812-634-1582
Practice Address - Street 1:1900 SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546
Practice Address - Country:US
Practice Address - Phone:812-634-1211
Practice Address - Fax:812-634-1582
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028986A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN215020BOtherMEDICARE GROUP #
IN211530Medicare ID - Type Unspecified
IN0682120001Medicare NSC
C24642Medicare UPIN