Provider Demographics
NPI:1710989686
Name:NEWTON, DALE C (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:C
Last Name:NEWTON
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 1:3011 MARTA CIR
Mailing Address - Street 2:APT 203
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-0750
Mailing Address - Country:US
Mailing Address - Phone:478-475-4071
Mailing Address - Fax:478-757-4948
Practice Address - Street 1:3011 MARTA CIR
Practice Address - Street 2:APT 203
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-0750
Practice Address - Country:US
Practice Address - Phone:478-475-4071
Practice Address - Fax:478-757-4948
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0419162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000714227HMedicaid
GA30BDLWDMedicare ID - Type Unspecified