Provider Demographics
NPI:1730967977
Name:NORRIS, TIMOTHY E
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:E
Last Name:NORRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 HOPPE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2313
Mailing Address - Country:US
Mailing Address - Phone:580-310-5719
Mailing Address - Fax:
Practice Address - Street 1:1400 HOPPE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2313
Practice Address - Country:US
Practice Address - Phone:580-310-5719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist