Provider Demographics
NPI:1306871660
Name:NORMAN, DAVID C (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:NORMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 FRANK SCOTT PARKWAY WEST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-5014
Mailing Address - Country:US
Mailing Address - Phone:618-257-2550
Mailing Address - Fax:618-257-2569
Practice Address - Street 1:3030 FRANK SCOTT PARKWAY WEST
Practice Address - Street 2:SUITE 1
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-5014
Practice Address - Country:US
Practice Address - Phone:618-257-2550
Practice Address - Fax:618-257-2569
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090116208000000X
IL03090116208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
056891OtherAMERICAN BOARD OF PEDIATR
IL036 090116Medicaid