Healthcare Provider Details

I. General information

NPI: 1629332952
Provider Name (Legal Business Name): TIMOTHY RYAN NEWTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SHARE DR STE 100
ALVA OK
73717-3614
US

IV. Provider business mailing address

800 SHARE DR STE 100
ALVA OK
73717-3614
US

V. Phone/Fax

Practice location:
  • Phone: 580-430-3366
  • Fax: 580-430-3354
Mailing address:
  • Phone: 580-430-3366
  • Fax: 580-430-3354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5255
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: