MEDICARE: MR. WILLIAM E NEWBERRY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	147	AK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00806322	OTHER	AK	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0147	OTHER	AK	PHYSICIAN ASSIST LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205917671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM E NEWBERRY PA-C

Provider Business Mailing Address
First Line	:	247 N FIREWEED ST
Second Line	:	SUITE A
City	:	SOLDOTNA
State	:	AK
Zip	:	99669-7540
Country	:	US
Telephone Number	:	907-262-8597
Fax Number	:	907-262-6516

Provider Business Practice Location Address
First Line	:	247 N FIREWEED ST
Second Line	:	SUITE A
City	:	SOLDOTNA
State	:	AK
Zip	:	99669-7540
Country	:	US
Telephone Number	:	907-262-8597
Fax Number	:	907-262-6516

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	03/07/2023

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Directions to “ MR. WILLIAM E NEWBERRY PA-C” Practice Location

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