MEDICARE: ZEPHRON GABRIEL NEWMARK MD

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	207Y00000X	Otolaryngology Physician	MD423763	PA
2	207Y00000X	Otolaryngology Physician	MD00018265	WA

General Provider Information

NPI Number	:	1811950744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZEPHRON GABRIEL NEWMARK MD

Provider Business Mailing Address
First Line	:	4545 POINT FOSDICK DR NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1700
Country	:	US
Telephone Number	:	253-530-8293
Fax Number	:

Provider Business Practice Location Address
First Line	:	4545 POINT FOSDICK DR NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1700
Country	:	US
Telephone Number	:	253-530-8293
Fax Number	:

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	11/29/2011

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