Provider Demographics
NPI:1518968726
Name:NORRIS, CHARLES RICHARD JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:RICHARD
Last Name:NORRIS
Suffix:JR
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 1:1499 W PALMETTO PARK RD STE 216
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-3322
Mailing Address - Country:US
Mailing Address - Phone:561-391-4669
Mailing Address - Fax:561-391-1815
Practice Address - Street 1:1499 W PALMETTO PARK RD STE 216
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-3322
Practice Address - Country:US
Practice Address - Phone:561-391-4669
Practice Address - Fax:561-391-1815
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2018-04-08
Deactivation Date:2006-04-06
Deactivation Code:
Reactivation Date:2006-04-11
Provider Licenses
StateLicense IDTaxonomies
FLME-00344402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
62304ZMedicare PIN
D57394Medicare UPIN