=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346595717
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSHUA JOSEPH NEWMAN PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2012
-----------------------------------------------------
Last Update Date | 07/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14825 N OUTER 40 RD
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63017-2152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-336-2555
-----------------------------------------------------
Fax | 314-336-2654
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3328 PIAZZA LN
-----------------------------------------------------
City | EDWARDSVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62025-3225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-520-3713
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | 2012024865
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------