Provider Demographics
NPI:1831119718
Name:NORMAN, RICHARD J (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:NORMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 JAMES WAY
Mailing Address - Street 2:STE. 205
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-4973
Mailing Address - Country:US
Mailing Address - Phone:805-773-3668
Mailing Address - Fax:805-773-1043
Practice Address - Street 1:2 JAMES WAY
Practice Address - Street 2:STE. 205
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-4973
Practice Address - Country:US
Practice Address - Phone:805-773-3668
Practice Address - Fax:805-773-1043
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4306213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7830250OtherAETNA PIN
CA00E43060OtherBLUE SHIELD PIN
CA00E430600Medicaid
CAE4306OtherBLUE CROSS
CAU85156Medicare UPIN
CAE4306OtherBLUE CROSS
5082600001Medicare NSC
E4306Medicare PIN