Provider Demographics
NPI:1821089012
Name:ERVIN, NORMAN (M D)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:ERVIN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BOB WALLACE AVE SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3847
Mailing Address - Country:US
Mailing Address - Phone:256-533-2303
Mailing Address - Fax:256-533-4212
Practice Address - Street 1:101 BOB WALLACE AVE SW
Practice Address - Street 2:SUITE B
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3847
Practice Address - Country:US
Practice Address - Phone:256-533-2303
Practice Address - Fax:256-533-4212
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10392207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51097556OtherBCBS
B30146Medicare UPIN
AL51097556OtherBCBS