Provider Demographics
NPI:1174558456
Name:NORRIS, DALE WAYNE (MD)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:WAYNE
Last Name:NORRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2801
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38557-2801
Mailing Address - Country:US
Mailing Address - Phone:931-879-5864
Mailing Address - Fax:931-879-0796
Practice Address - Street 1:101 S DUNCAN ST STE C
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-3007
Practice Address - Country:US
Practice Address - Phone:931-879-5864
Practice Address - Fax:931-879-0796
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD16620208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN110000878Medicare PIN
30180601Medicare PIN