Provider Demographics
NPI:1578521886
Name:NORCROSS, DAVID COPELAND (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:COPELAND
Last Name:NORCROSS
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 1:2210 KING BLVD
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:88260
Mailing Address - Country:US
Mailing Address - Phone:307-577-4240
Mailing Address - Fax:307-577-0012
Practice Address - Street 1:2210 KING BLVD
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604
Practice Address - Country:US
Practice Address - Phone:307-577-4240
Practice Address - Fax:307-577-0012
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7365A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY122831500Medicaid
WY314191OtherBCBS
WY122831500Medicaid
WY20819Medicare PIN