Provider Demographics
NPI:1871596841
Name:NORTON, BENNETTE EDWARD III (MD)
Entity type:Individual
Prefix:DR
First Name:BENNETTE
Middle Name:EDWARD
Last Name:NORTON
Suffix:III
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 1:170 FORD RD
Mailing Address - Street 2:
Mailing Address - City:JOHN DAY
Mailing Address - State:OR
Mailing Address - Zip Code:97845-2009
Mailing Address - Country:US
Mailing Address - Phone:541-575-1311
Mailing Address - Fax:541-575-0650
Practice Address - Street 1:180 FORD ROAD
Practice Address - Street 2:
Practice Address - City:JOHN DAY
Practice Address - State:OR
Practice Address - Zip Code:97845
Practice Address - Country:US
Practice Address - Phone:541-575-0404
Practice Address - Fax:541-575-1124
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045290207Q00000X
TNMD 18994207Q00000X
ORMD151877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5651468Medicaid
ORR168757Medicare PIN
A99769Medicare UPIN
TN3034154Medicare ID - Type Unspecified
TN3034158Medicare ID - Type Unspecified