Provider Demographics
NPI:1609805845
Name:NEWLANDER, JOHN KELLY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KELLY
Last Name:NEWLANDER
Suffix:
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 1:973 E CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3605
Mailing Address - Country:US
Mailing Address - Phone:805-473-9648
Mailing Address - Fax:
Practice Address - Street 1:117 W BUNNY AVE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-2805
Practice Address - Country:US
Practice Address - Phone:805-739-3890
Practice Address - Fax:805-347-7697
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82254207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A822540Medicaid
CAH85457Medicare UPIN
CA00A822540Medicaid