Provider Demographics
NPI:1366496648
Name:NEWEY, MARK WAYNE (DO)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:WAYNE
Last Name:NEWEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 905
Mailing Address - Street 2:
Mailing Address - City:HEALDTON
Mailing Address - State:OK
Mailing Address - Zip Code:73438-0905
Mailing Address - Country:US
Mailing Address - Phone:580-229-2333
Mailing Address - Fax:580-229-0924
Practice Address - Street 1:628 4TH STREET
Practice Address - Street 2:
Practice Address - City:HEALDTON
Practice Address - State:OK
Practice Address - Zip Code:73438
Practice Address - Country:US
Practice Address - Phone:580-229-2333
Practice Address - Fax:580-229-0924
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2185207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100095690BMedicaid
OKE09615Medicare UPIN