MEDICARE: DR. ROBERT JASON NEWSOM M.D., M.P.H.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0901X	Public Health & General Preventive Medicine Physician	94571	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	045102	OTHER	GA	STATE LICENSE
2	ME 94571	OTHER	FL	STATE LICENSE

General Provider Information

NPI Number	:	1306846761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT JASON NEWSOM M.D., M.P.H.

Provider Business Mailing Address
First Line	:	1406 MARYLAND AVE
Second Line	:
City	:	LYNN HAVEN
State	:	FL
Zip	:	32444-2044
Country	:	US
Telephone Number	:	850-872-9752
Fax Number	:

Provider Business Practice Location Address
First Line	:	1406 MARYLAND AVE
Second Line	:
City	:	LYNN HAVEN
State	:	FL
Zip	:	32444-2044
Country	:	US
Telephone Number	:	850-872-9752
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	08/24/2009

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