Healthcare Provider Details

I. General information

NPI: 1417229485
Provider Name (Legal Business Name): VERNON LEE NEWBY DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 MADISON BLVD.
BARTLESVILLE OK
74006
US

IV. Provider business mailing address

817 MADISON BLVD.
BARTLESVILLE OK
74006
US

V. Phone/Fax

Practice location:
  • Phone: 918-333-0247
  • Fax: 918-333-0249
Mailing address:
  • Phone: 918-333-0247
  • Fax: 918-333-0249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number2071
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: