Provider Demographics
NPI:1336207588
Name:NORTON, TERRENCE JOHN (MD)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:JOHN
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 1:1450 EASTSIDE RD
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-9800
Mailing Address - Country:US
Mailing Address - Phone:608-342-3019
Mailing Address - Fax:608-342-3025
Practice Address - Street 1:1450 EASTSIDE RD
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-9800
Practice Address - Country:US
Practice Address - Phone:608-342-3019
Practice Address - Fax:608-342-3025
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI446392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34380000Medicaid
H84076Medicare UPIN
017400480Medicare ID - Type Unspecified