Provider Demographics
NPI:1689751901
Name:NORRIS, JOHN FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDERICK
Last Name:NORRIS
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 1:516 LAKEVIEW RD
Mailing Address - Street 2:VILLA 5
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3302
Mailing Address - Country:US
Mailing Address - Phone:727-587-6999
Mailing Address - Fax:727-581-0064
Practice Address - Street 1:516 LAKEVIEW RD
Practice Address - Street 2:VILLA 5
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3302
Practice Address - Country:US
Practice Address - Phone:727-587-6999
Practice Address - Fax:727-581-0064
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70306207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261643200Medicaid
FL261643200Medicaid
FLE36708Medicare UPIN