Provider Demographics
NPI:1326087263
Name:NORCOM, DEREK F (MD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:F
Last Name:NORCOM
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 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:629-224-1621
Mailing Address - Fax:
Practice Address - Street 1:7313 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2007
Practice Address - Country:US
Practice Address - Phone:405-251-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21044207Q00000X
TN67415207Q00000X
OK43670207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR151180Medicaid
OR151180Medicaid
ORR152875Medicare PIN
ORR101917Medicare PIN
ORR152878Medicare PIN
ORG72757Medicare UPIN
ORR152877Medicare PIN
ORR152872Medicare PIN
ORR152873Medicare PIN