Provider Demographics
NPI:1932190543
Name:ZELLERS, NORMAN DALE (PAC)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:DALE
Last Name:ZELLERS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 FISHER ST # 81MDOS
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39534-2508
Mailing Address - Country:US
Mailing Address - Phone:229-376-0500
Mailing Address - Fax:
Practice Address - Street 1:301 FISHER ST # 81MDOS
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39534-2508
Practice Address - Country:US
Practice Address - Phone:229-376-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00732363A00000X
NVPA976363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00015668OtherRAILROAD MEDICARE
1012437OtherHEALTH ADVANTAGE (PPO)
140289OtherGREAT LAKES HEALTH PLAN
2832651OtherMOLINA HEALTH CARE OF MI
1012437OtherMCLAREN HEALTH PLAN
247OtherCOMMUNITY CHOICE OF MICHI
1012437OtherMCLAREN HEALTH PLAN
1012437OtherHEALTH ADVANTAGE (PPO)