Healthcare Provider Details

I. General information

NPI: 1386270783
Provider Name (Legal Business Name): CODY FRANKLIN NEWELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-EMR 3551 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4504
US

IV. Provider business mailing address

SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-EMR 3551 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-4789
  • Fax: 210-916-6654
Mailing address:
  • Phone: 210-916-4789
  • Fax: 210-916-6654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberT4442
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: