Provider Demographics
NPI:1518959188
Name:NEWSOM, WILLIAM A JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:NEWSOM
Suffix:JR
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:PO BOX 1549
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-1549
Mailing Address - Country:US
Mailing Address - Phone:530-274-6677
Mailing Address - Fax:530-274-6678
Practice Address - Street 1:155 GLASSON WAY
Practice Address - Street 2:SUITE L10
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5723
Practice Address - Country:US
Practice Address - Phone:530-274-6677
Practice Address - Fax:530-274-6678
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27012207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ02732ZOtherCURRENT MEDICARE PTAN -GROUP
DF1247OtherRAILROAD MEDICARE GROUP PTAN CURRENT AS OF 08/2010
CAP00341945OtherRAILROAD MEDICARE PTAN
CAGR0061600OtherST OF CA MEDI-CAL #
DF1247OtherRAILROAD MEDICARE GROUP PTAN CURRENT AS OF 08/2010
20-5308894OtherCURRENT TAX ID NUMBER 11/06
CA00G270122Medicare PIN
CAP00341945OtherRAILROAD MEDICARE PTAN
CAA89441Medicare UPIN