Provider Demographics
NPI:1528032919
Name:NEWMAN, JEFFREY STEPHEN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:STEPHEN
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 E MAIN AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3116
Mailing Address - Country:US
Mailing Address - Phone:253-841-2453
Mailing Address - Fax:253-840-5519
Practice Address - Street 1:929 E MAIN AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3116
Practice Address - Country:US
Practice Address - Phone:253-841-2453
Practice Address - Fax:253-840-5519
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047170207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7095656 GROUPMedicaid
CS6844 GROUPOtherRR MEDICARE
P00443871OtherRR MEDICARE
WA8475642Medicaid
WA217912OtherL&I
WA53030 GROUPOtherL&I
WA7095656 GROUPMedicaid
WAG8867013Medicare PIN