Provider Demographics
NPI:1679731871
Name:PACKER, NORMAN DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:DOUGLAS
Last Name:PACKER
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 1:110 OVERLOOK POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-8642
Mailing Address - Country:US
Mailing Address - Phone:601-853-2065
Mailing Address - Fax:
Practice Address - Street 1:110 OVERLOOK POINTE CIR
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-8642
Practice Address - Country:US
Practice Address - Phone:601-853-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-26
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10312207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology