Provider Demographics
NPI:1225335599
Name:NEWBROUGH, MARK GEORGE (MD FACS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:GEORGE
Last Name:NEWBROUGH
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 36TH AVENUE NE
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-4209
Mailing Address - Country:US
Mailing Address - Phone:406-788-6281
Mailing Address - Fax:
Practice Address - Street 1:324 36TH AVENUE NE
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-4209
Practice Address - Country:US
Practice Address - Phone:406-788-6281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7750208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery