Provider Demographics
NPI:1841276102
Name:NORRIS, KENNETH JEWELL JR (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:JEWELL
Last Name:NORRIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2908
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2908
Mailing Address - Country:US
Mailing Address - Phone:425-207-5155
Mailing Address - Fax:
Practice Address - Street 1:1200 W NORTHERN LIGHTS BLVD STE B
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3652
Practice Address - Country:US
Practice Address - Phone:907-212-5165
Practice Address - Fax:907-212-0950
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2025-06-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD071034L207Q00000X
AK5912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2374Medicaid
AK8EK992Medicare PIN