Provider Demographics
NPI:1831145150
Name:NORTON, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:NORTON
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 1:3470 CENTENNIAL BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4090
Mailing Address - Country:US
Mailing Address - Phone:719-635-3355
Mailing Address - Fax:719-635-3366
Practice Address - Street 1:3470 CENTENNIAL BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4090
Practice Address - Country:US
Practice Address - Phone:719-635-3355
Practice Address - Fax:719-635-3366
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19871207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01198712Medicaid
COJ50024Medicare ID - Type Unspecified
CO01198712Medicaid