Provider Demographics
NPI:1619934155
Name:NEWMYER, CAROL (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:NEWMYER
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 1:1815 N STOCKTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-4667
Mailing Address - Country:US
Mailing Address - Phone:928-753-2888
Mailing Address - Fax:928-753-9350
Practice Address - Street 1:1815 N STOCKTON HILL RD
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-4667
Practice Address - Country:US
Practice Address - Phone:928-753-2888
Practice Address - Fax:928-753-9350
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18661174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0261790OtherBC/BS
AZ287723OtherAHCCCS ID NUMBER
AZAZ0261790OtherBC/BS