Provider Demographics
NPI:1164497020
Name:NORMAN, VICTOR D (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:D
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 1:221 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:RED BAY
Mailing Address - State:AL
Mailing Address - Zip Code:35582-3858
Mailing Address - Country:US
Mailing Address - Phone:256-356-8907
Mailing Address - Fax:256-356-8903
Practice Address - Street 1:221 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:RED BAY
Practice Address - State:AL
Practice Address - Zip Code:35582-3858
Practice Address - Country:US
Practice Address - Phone:256-356-8907
Practice Address - Fax:256-356-8903
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7490207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00012717Medicaid
ALP00019459OtherRAILROAD MEDICARE
AL7109233347OtherTRICARE
AL51513801OtherBCBS
AL51513801OtherBCBS