Provider Demographics
NPI:1841475746
Name:DAVID C. NORMAN MD INC
Entity type:Organization
Organization Name:DAVID C. NORMAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-257-2550
Mailing Address - Street 1:3030 FRANK SCOTT PARKWAY WEST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-5014
Mailing Address - Country:US
Mailing Address - Phone:618-257-2550
Mailing Address - Fax:618-257-2569
Practice Address - Street 1:3030 FRANK SCOTT PARKWAY WEST
Practice Address - Street 2:SUITE 1
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-5014
Practice Address - Country:US
Practice Address - Phone:618-257-2550
Practice Address - Fax:618-257-2569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036090116Medicaid