Provider Demographics
NPI:1760456941
Name:NORDNESS, PAUL JORGEN (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JORGEN
Last Name:NORDNESS
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 1:419 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5101
Mailing Address - Country:US
Mailing Address - Phone:256-547-6331
Mailing Address - Fax:256-547-1711
Practice Address - Street 1:419 S 5TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5101
Practice Address - Country:US
Practice Address - Phone:256-547-6331
Practice Address - Fax:256-547-1711
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.33742208600000X
TN69610152086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000207838Medicaid
AL5122074OtherBLUE CROSS BLUE SHIELD OF ALABAMA
NCP00231764OtherMEDICARE RAIL ROAD
NC891376WMedicaid
NCD9505OtherMED COST
NC2034515Medicare PIN
NC1376WOtherNC BLUE CROSS BLUE SHIELD