Provider Demographics
NPI:1770553075
Name:NORVILL, KEITH A (DO)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:NORVILL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 GARDEN EDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6084
Mailing Address - Country:US
Mailing Address - Phone:719-248-4260
Mailing Address - Fax:
Practice Address - Street 1:180 MEDICAL PARK PL STE 201
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8067
Practice Address - Country:US
Practice Address - Phone:719-248-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ 3562207T00000X
CO49685207T00000X
ARE-12658207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1005811 02Medicaid
COP00997257OtherRAILROAD MEDICARE
CO45757810Medicaid
TX1005811 02Medicaid
TX85880KMedicare ID - Type UnspecifiedMEDICARE ID NUMBER