Healthcare Provider Details
I. General information
NPI: 1194975409
Provider Name (Legal Business Name): NEWMAN, M.D. PLASTIC SURGERY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/23/2008
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
130 E 9TH ST
MOUNTAIN HOME AR
72653-4704
US
IV. Provider business mailing address
130 E 9TH ST
MOUNTAIN HOME AR
72653-4704
US
V. Phone/Fax
- Phone: 870-425-6398
- Fax: 870-425-6402
- Phone: 870-425-6398
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208200000X |
| Taxonomy | Plastic Surgery Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
ADAM
G.
NEWMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 879-425-6398