Provider Demographics
NPI:1801837042
Name:NORRIS, TIMOTHY J (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
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 1:1646 ELDRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-7817
Mailing Address - Country:US
Mailing Address - Phone:208-734-7362
Mailing Address - Fax:208-733-9463
Practice Address - Street 1:1646 ELDRIDGE AVE
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-7817
Practice Address - Country:US
Practice Address - Phone:208-734-7362
Practice Address - Fax:208-733-9463
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5350207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000116300Medicaid
C97193Medicare UPIN
ID1120205Medicare ID - Type Unspecified