Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 040500 | GA |
N | 207YP0228X | Pediatric Otolaryngology | 040500 | GA |
NPI | 1457332272 |
---|---|
Provider Name | Dr. Norman Novelly |
First Address | Shiprock, NM 87420-0160 |
Second Address | Shiprock, NM 87420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 28/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00669721E | (05) | GA |
A79328 | (02) | GA |
AN2126515 | DEA (01) | GA |