Provider Demographics
NPI:1346509874
Name:NEWSON, SHAD DANIAL (MD)
Entity Type:Individual
Prefix:
First Name:SHAD
Middle Name:DANIAL
Last Name:NEWSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 PURPLE SAGE RD
Mailing Address - Street 2:
Mailing Address - City:DALHART
Mailing Address - State:TX
Mailing Address - Zip Code:79022-8044
Mailing Address - Country:US
Mailing Address - Phone:801-636-4311
Mailing Address - Fax:806-244-9397
Practice Address - Street 1:1250 E 3900 S
Practice Address - Street 2:SUITE 260
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1348
Practice Address - Country:US
Practice Address - Phone:801-265-2000
Practice Address - Fax:801-265-2008
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine