Provider Demographics
NPI:1588640759
Name:CLINKSCALES, NORMAN BULL (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:BULL
Last Name:CLINKSCALES
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1005 MAR WALT DRIVE
Mailing Address - Street 2:RADIOLOGY DEPARTMENT
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6707
Mailing Address - Country:US
Mailing Address - Phone:850-863-8110
Mailing Address - Fax:850-863-8245
Practice Address - Street 1:1005 MAR WALT DRIVE
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6707
Practice Address - Country:US
Practice Address - Phone:850-863-8110
Practice Address - Fax:850-863-8245
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME1013812085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30501OtherBCBSFL
FL000061900Medicaid
FLD47050Medicare UPIN
FL000061900Medicaid