Basic Information
| Provider Information | |||||||||
| NPI: | 1629072079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NORMAN | ||||||||
| FirstName: | H. | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1325 SAN MARCO BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322078568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043463465 | ||||||||
| FaxNumber: | 9043889644 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 SHIRCLIFF WAY STE 300 | ||||||||
| Address2: | CREDENTIALING DEPARTMENT | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322044753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043881400 | ||||||||
| FaxNumber: | 9043889644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2005 | ||||||||
| LastUpdateDate: | 11/17/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | ME22896 | FL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0114X | ME22896 | FL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 406202630 | 01 | FL | RR MEDICARE | OTHER | 009424700 | 05 | FL | MEDICAID |