Provider Demographics
NPI:1558579755
Name:NORMAN, ROBERT MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MITCHELL
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 1:1213 WATERS DAIRY RD APT 103
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-3426
Mailing Address - Country:US
Mailing Address - Phone:972-898-1478
Mailing Address - Fax:
Practice Address - Street 1:444 N PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3006
Practice Address - Country:US
Practice Address - Phone:618-436-5665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM58572084P0800X
CA1625992084P0800X
IL0361501342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry