Provider Demographics
NPI:1912019019
Name:NEW, RONALD BRENT (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:BRENT
Last Name:NEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-3000
Mailing Address - Fax:573-331-5073
Practice Address - Street 1:3250 GORDONVILLE RD
Practice Address - Street 2:SUITE 358
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5056
Practice Address - Country:US
Practice Address - Phone:573-331-5589
Practice Address - Fax:573-331-5096
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2016033283208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1912019019Medicaid
MO1912019019Medicaid
TX194348201Medicaid
TX74-1796484OtherCTVS - TAX ID NUMBER
TX8S2802OtherBLUECROSS BLUESHIELD OF TEXAS
MO1912019019Medicaid