Provider Demographics
NPI:1679680052
Name:NEWTON, JACK RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:RONALD
Last Name:NEWTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8019 DIXIE HWY SUITE 101
Mailing Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL VALLEY STATION, LLC
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258
Mailing Address - Country:US
Mailing Address - Phone:502-333-3121
Mailing Address - Fax:502-333-3131
Practice Address - Street 1:2526 WESLEYAN PARK DR
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-5430
Practice Address - Country:US
Practice Address - Phone:270-929-6608
Practice Address - Fax:502-333-3131
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY174400000X174400000X
KY18927207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64189277Medicaid
KY64189277Medicaid
KY1035801Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER