Provider Demographics
NPI:1942201967
Name:NEWGENT, ERIC W (DO)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:W
Last Name:NEWGENT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 VOYAGER DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-8303
Mailing Address - Country:US
Mailing Address - Phone:920-361-5717
Mailing Address - Fax:920-361-6361
Practice Address - Street 1:191 MEMORIAL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923-1241
Practice Address - Country:US
Practice Address - Phone:920-361-5717
Practice Address - Fax:920-361-6361
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36180207QS1201X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30065200Medicaid
WI30065200Medicaid
WI004160167Medicare PIN