Healthcare Provider Details

I. General information

NPI: 1780212886
Provider Name (Legal Business Name): AVERY NEWCOMB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 08/18/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 HOSPITAL DR STE B
UKIAH CA
95482-4556
US

IV. Provider business mailing address

242 HOSPITAL DR STE B
UKIAH CA
95482-4556
US

V. Phone/Fax

Practice location:
  • Phone: 707-462-7900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA188905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: