Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 4301070997 | MI |
Y | 207QS0010X | Family Doctor - Sports Medicine | 4301070997 | MI |
NPI | 1184738783 |
---|---|
Provider Name | Dr. Robert E Norris |
First Address | East Lansing, MI 48824-7015 |
Second Address | East Lansing, MI 48823-5376 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 05/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1184738783 | (05) | MI |
4432819 | (05) | MI |
H43260 | (02) | MI |