Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 5993 | TX |
NPI | 1528114766 |
---|---|
Provider Name | Michael J Norman |
First Address | Carrollton, TX 75007-2474 |
Second Address | Carrollton, TX 75007-2474 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5993 | TEXAS LICENSE NUMBER (01) | TX |
75-2443943 | EMPLOYER ID (01) | TX |