Provider Demographics
NPI:1396184420
Name:NORRIS, NATHAN BLAKE (MD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:BLAKE
Last Name:NORRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13620
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73113-1629
Mailing Address - Country:US
Mailing Address - Phone:405-445-1210
Mailing Address - Fax:405-445-3310
Practice Address - Street 1:7107 S MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:HAYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:67060-7678
Practice Address - Country:US
Practice Address - Phone:316-858-8580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK35371207Q00000X
KS04-38701207Q00000X
MO2015014717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine