Healthcare Provider Details

I. General information

NPI: 1306846761
Provider Name (Legal Business Name): ROBERT JASON NEWSOM M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 MARYLAND AVE
LYNN HAVEN FL
32444-2044
US

IV. Provider business mailing address

1406 MARYLAND AVE
LYNN HAVEN FL
32444-2044
US

V. Phone/Fax

Practice location:
  • Phone: 850-872-9752
  • Fax:
Mailing address:
  • Phone: 850-872-9752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number94571
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: