Healthcare Provider Details

I. General information

NPI: 1750362794
Provider Name (Legal Business Name): THOMAS JOHN NEWTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 ELM ST E CENTRACARE CLINIC ST JOSEPH FAMILY MEDICINE
SAINT JOSEPH MN
56374-4694
US

IV. Provider business mailing address

1360 ELM ST E CENTRACARE CLINIC ST JOSEPH FAMILY MEDICINE
SAINT JOSEPH MN
56374-4694
US

V. Phone/Fax

Practice location:
  • Phone: 320-363-7765
  • Fax: 320-363-0031
Mailing address:
  • Phone: 320-363-7765
  • Fax: 320-363-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24499
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: