Provider Demographics
NPI:1891792974
Name:NORMAN, HOWARD GENE (DO)
Entity type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:GENE
Last Name:NORMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-1906
Mailing Address - Country:US
Mailing Address - Phone:623-925-0361
Mailing Address - Fax:623-932-3674
Practice Address - Street 1:425 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1906
Practice Address - Country:US
Practice Address - Phone:623-925-0361
Practice Address - Fax:623-932-3674
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0970208D00000X
MO32357208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ204222Medicaid
AZ204222Medicaid