Provider Demographics
NPI:1174558456
Name:NORRIS, DALE WAYNE (MD)
Entity type:Individual
Prefix:MR
First Name:DALE
Middle Name:WAYNE
Last Name:NORRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:959 SNOWDEN FARM RD
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-8988
Mailing Address - Country:US
Mailing Address - Phone:901-229-1157
Mailing Address - Fax:901-221-0125
Practice Address - Street 1:5475 POPLAR AVE
Practice Address - Street 2:STE.106
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3730
Practice Address - Country:US
Practice Address - Phone:901-254-8040
Practice Address - Fax:901-435-6522
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD16620208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN110000878Medicare PIN
30180601Medicare PIN