Provider Demographics
NPI:1902001621
Name:NORRIS, BARRY D (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:D
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 1:2930 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2833
Mailing Address - Country:US
Mailing Address - Phone:831-475-7400
Mailing Address - Fax:831-477-2081
Practice Address - Street 1:2930 PARK AVE
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2833
Practice Address - Country:US
Practice Address - Phone:831-475-7400
Practice Address - Fax:831-477-2081
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42711207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G427110Medicaid
00G427110Medicare ID - Type Unspecified
CAA48082Medicare UPIN
CA00G427110Medicaid