Healthcare Provider Details

I. General information

NPI: 1467430504
Provider Name (Legal Business Name): NEWTON G YCO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S MEADOWS PKWY STE 400
RENO NV
89521-2972
US

IV. Provider business mailing address

800 S MEADOWS PKWY STE 400
RENO NV
89521-2972
US

V. Phone/Fax

Practice location:
  • Phone: 775-853-8888
  • Fax: 775-853-8288
Mailing address:
  • Phone: 775-853-8888
  • Fax: 775-853-8288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number976
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: