Provider Demographics
NPI:1447252788
Name:NORMAN, WARREN T (MD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:T
Last Name:NORMAN
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:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-0229
Mailing Address - Country:US
Mailing Address - Phone:662-620-7102
Mailing Address - Fax:662-620-7106
Practice Address - Street 1:205 MARENGO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-6033
Practice Address - Country:US
Practice Address - Phone:256-381-0400
Practice Address - Fax:256-365-0065
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00016553174400000X
ALMD.165532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009911639Medicaid
AL009971885Medicaid
C300OtherMC GROUP
AL051519728Medicaid
AL51543275OtherBC EAST
AL000055298OtherMEDICARE PROVIDER NUMBER
AL009934439Medicaid
AL009934441Medicaid
AL51519728OtherBC ECM
AL51524659OtherBC OBGYN
AL51531779OtherBC RUSSELLVILLE
AL51543141OtherBC SHOALS
AL009911641Medicaid
AL51531778OtherBC HALEYVILLE
AL528202620Medicaid
AL051519728NORMedicare ID - Type Unspecified
AL051519728Medicaid