Provider Demographics
NPI:1588636559
Name:CHARLES R NORRIS JR MD PA
Entity Type:Organization
Organization Name:CHARLES R NORRIS JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:561-482-7850
Mailing Address - Street 1:7301 A WEST PALMETTO PK RD
Mailing Address - Street 2:SUITE 106C
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433
Mailing Address - Country:US
Mailing Address - Phone:561-482-7850
Mailing Address - Fax:561-391-1815
Practice Address - Street 1:7301 A WEST PALMETTO PK RD
Practice Address - Street 2:SUITE 106C
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433
Practice Address - Country:US
Practice Address - Phone:561-482-7850
Practice Address - Fax:561-391-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00344402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D57394Medicare UPIN
CK334AMedicare PIN