MEDICARE: DR. WALTER SCOTT NEWSOM PH.D.

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	103T00000X	Psychologist	31249	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275526212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER SCOTT NEWSOM PH.D.

Provider Business Mailing Address
First Line	:	2101 LANIER DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-7736
Country	:	US
Telephone Number	:	855-640-1700
Fax Number	:	855-640-1700

Provider Business Practice Location Address
First Line	:	8500 SHOAL CREEK BLVD
Second Line	:	BUILDING 4, SUITE 201A
City	:	AUSTIN
State	:	TX
Zip	:	78757-7591
Country	:	US
Telephone Number	:	855-640-1700
Fax Number	:	855-640-1700

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	02/08/2017

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