Provider Demographics
NPI:1558325035
Name:NEWSUM, JON K (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:K
Last Name:NEWSUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 65978
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28265
Mailing Address - Country:US
Mailing Address - Phone:501-771-4693
Mailing Address - Fax:501-771-4885
Practice Address - Street 1:1701 S SHACKLEFORD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211
Practice Address - Country:US
Practice Address - Phone:501-771-4693
Practice Address - Fax:501-771-4885
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC4399207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103864001Medicaid
AR103864001Medicaid
AR53843Medicare PIN