Healthcare Provider Details

I. General information

NPI: 1558325035
Provider Name (Legal Business Name): JON K NEWSUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 S SHACKLEFORD
LITTLE ROCK AR
72211
US

IV. Provider business mailing address

PO BOX 65978
CHARLOTTE NC
28265
US

V. Phone/Fax

Practice location:
  • Phone: 501-771-4693
  • Fax: 501-771-4885
Mailing address:
  • Phone: 501-771-4693
  • Fax: 501-771-4885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC4399
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: