Healthcare Provider Details

I. General information

NPI: 1225335599
Provider Name (Legal Business Name): MARK GEORGE NEWBROUGH MD FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 36TH AVENUE NE
GREAT FALLS MT
59404-4209
US

IV. Provider business mailing address

324 36TH AVENUE NE
GREAT FALLS MT
59404-4209
US

V. Phone/Fax

Practice location:
  • Phone: 406-788-6281
  • Fax:
Mailing address:
  • Phone: 406-788-6281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number7750
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: