Provider Demographics
NPI:1720003031
Name:NORRIS, BRIAN BLAKE (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:BLAKE
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 1:9501 LILE DR
Mailing Address - Street 2:STE 600
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6225
Mailing Address - Country:US
Mailing Address - Phone:501-227-7596
Mailing Address - Fax:501-978-1919
Practice Address - Street 1:9501 LILE DR
Practice Address - Street 2:STE 600
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6225
Practice Address - Country:US
Practice Address - Phone:501-227-7596
Practice Address - Fax:501-978-1919
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2868207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR161583001Medicaid
AR161583001Medicaid
AR5N507Medicare PIN