Provider Demographics
NPI:1235173543
Name:NORMAN, BRIAN T (PA C)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:T
Last Name:NORMAN
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
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Mailing Address - Street 1:1015 E 32ND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2707
Mailing Address - Country:US
Mailing Address - Phone:512-476-2830
Mailing Address - Fax:512-583-1099
Practice Address - Street 1:12523 S CREEK MEADOW RD STE 109
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7299
Practice Address - Country:US
Practice Address - Phone:801-251-0735
Practice Address - Fax:512-583-1099
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT9557601-1206363A00000X
TX9557601-1206363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT9557601-1206OtherHEALTH AND WELLNESS
TXPA04216OtherSTATE LICENSE NUMBER