Provider Demographics
NPI:1356343271
Name:NORRIS, LARRY C (PA)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:C
Last Name:NORRIS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1010
Mailing Address - Street 2:
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467-1010
Mailing Address - Country:US
Mailing Address - Phone:334-493-5555
Mailing Address - Fax:334-493-0517
Practice Address - Street 1:103 E MEMORIAL AVE
Practice Address - Street 2:
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-1746
Practice Address - Country:US
Practice Address - Phone:334-493-5555
Practice Address - Fax:334-493-0517
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-195363A00000X
ALPA195363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891007920Medicaid
AL515-21930OtherBCBS OF AL 4300 W. MAIN
AL051521929OtherMEDICARE
AL515-21929OtherBCBS OF AL 1500 RCC
AL891007910Medicaid
AL515-21930OtherBCBS OF AL 4300 W. MAIN
AL891007920Medicaid