Healthcare Provider Details

I. General information

NPI: 1942216924
Provider Name (Legal Business Name): JAMES MARSHALL NEWBERN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: J MARSHALL NEWBERN DO

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 N 3RD STREET
PHOENIX AZ
85012
US

IV. Provider business mailing address

3003 N 3RD STREET
PHOENIX AZ
85012
US

V. Phone/Fax

Practice location:
  • Phone: 602-282-9800
  • Fax: 602-393-9848
Mailing address:
  • Phone: 602-282-9800
  • Fax: 866-837-6575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP00001919
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101008957
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number006228
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: