Provider Demographics
NPI:1851692867
Name:TERRY D. NEWSOM, M.D., P.A.
Entity Type:Organization
Organization Name:TERRY D. NEWSOM, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:NEWSOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-519-1100
Mailing Address - Street 1:2701 W 15TH ST # 550
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7523
Mailing Address - Country:US
Mailing Address - Phone:214-842-4983
Mailing Address - Fax:214-842-4983
Practice Address - Street 1:4005 W 15TH ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5818
Practice Address - Country:US
Practice Address - Phone:972-519-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-07
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8366207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000000M735OtherBLUE SHIELD OF TEXAS
TX000000M735OtherBLUE SHIELD OF TEXAS