Provider Demographics
NPI:1710284062
Name:JACK D. NORMAN, M.D., P.A.
Entity Type:Organization
Organization Name:JACK D. NORMAN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:D
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-667-1224
Mailing Address - Street 1:848 BRICKELL AVE
Mailing Address - Street 2:SUITE #820
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2949
Mailing Address - Country:US
Mailing Address - Phone:305-358-7110
Mailing Address - Fax:305-379-6777
Practice Address - Street 1:848 BRICKELL AVE
Practice Address - Street 2:SUITE #820
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-2949
Practice Address - Country:US
Practice Address - Phone:305-358-7110
Practice Address - Fax:305-379-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
91485Medicare PIN
D59663Medicare UPIN