Provider Demographics
NPI:1750464236
Name:NORMAN, TERESA GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:GAIL
Last Name:NORMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4907 LONDONDERRY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1333
Mailing Address - Country:US
Mailing Address - Phone:813-728-5157
Mailing Address - Fax:813-979-9526
Practice Address - Street 1:4907 LONDONDERRY DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-1333
Practice Address - Country:US
Practice Address - Phone:813-728-5157
Practice Address - Fax:813-979-9526
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD69011Medicare UPIN
FL33776Medicare ID - Type Unspecified