Healthcare Provider Details

I. General information

NPI: 1952395196
Provider Name (Legal Business Name): JOHN NEWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 DAVID DR SUITE A
MORGAN CITY LA
70380-1300
US

IV. Provider business mailing address

1234 DAVID DR SUITE A
MORGAN CITY LA
70380-1300
US

V. Phone/Fax

Practice location:
  • Phone: 985-384-2430
  • Fax: 985-384-2473
Mailing address:
  • Phone: 985-384-2430
  • Fax: 985-384-2473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number06766R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: