Provider Demographics
NPI:1760838759
Name:NORMAN, CARL A (INDEPENDENT DUTY HM)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:A
Last Name:NORMAN
Suffix:
Gender:M
Credentials:INDEPENDENT DUTY HM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 THUNDER GLN
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-3976
Mailing Address - Country:US
Mailing Address - Phone:703-906-8615
Mailing Address - Fax:
Practice Address - Street 1:630 THUNDER GLN
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-3976
Practice Address - Country:US
Practice Address - Phone:703-906-8615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman