Provider Demographics
NPI:1306846761
Name:NEWSOM, ROBERT JASON (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JASON
Last Name:NEWSOM
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-2044
Mailing Address - Country:US
Mailing Address - Phone:850-872-9752
Mailing Address - Fax:
Practice Address - Street 1:1406 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-2044
Practice Address - Country:US
Practice Address - Phone:850-872-9752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL945712083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA045102OtherSTATE LICENSE
FLME 94571OtherSTATE LICENSE