Provider Demographics
NPI:1750498259
Name:NEWCOMER, JACK IRVIN (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:IRVIN
Last Name:NEWCOMER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3319 STATE ROAD 7
Mailing Address - Street 2:108
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8094
Mailing Address - Country:US
Mailing Address - Phone:561-798-2800
Mailing Address - Fax:561-793-6631
Practice Address - Street 1:3319 STATE ROAD 7
Practice Address - Street 2:STE 108
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8067
Practice Address - Country:US
Practice Address - Phone:561-798-2800
Practice Address - Fax:561-793-6631
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2016-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0048252207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD57261Medicare UPIN
FL61505YMedicare PIN