Provider Demographics
NPI:1407822943
Name:NEWSOM, CHRISTINE MUELLER (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MUELLER
Last Name:NEWSOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 JOERSCHKE DR
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5288
Mailing Address - Country:US
Mailing Address - Phone:530-477-4480
Mailing Address - Fax:530-477-3100
Practice Address - Street 1:409 JOERSCHKE DR
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5288
Practice Address - Country:US
Practice Address - Phone:530-477-4480
Practice Address - Fax:530-477-3100
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25383207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G253830Medicaid
CA00G253830Medicare ID - Type Unspecified
CA00G253830Medicaid