Provider Demographics
NPI:1215954805
Name:NORMAN, JAMES L (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:NORMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-924-1357
Practice Address - Street 1:1650 W MAGNOLIA
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4010
Practice Address - Country:US
Practice Address - Phone:817-924-4464
Practice Address - Fax:817-924-1357
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD8369208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032970802Medicaid
020054468OtherRAILROAD MEDICARE
020054468OtherRAILROAD MEDICARE