Provider Demographics
NPI:1942216924
Name:NEWBERN, JAMES MARSHALL (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MARSHALL
Last Name:NEWBERN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:J
Other - Middle Name:MARSHALL
Other - Last Name:NEWBERN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:3003 N 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012
Mailing Address - Country:US
Mailing Address - Phone:602-282-9800
Mailing Address - Fax:866-837-6575
Practice Address - Street 1:3003 N 3RD STREET
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012
Practice Address - Country:US
Practice Address - Phone:602-282-9800
Practice Address - Fax:602-393-9848
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001919207Q00000X
MI5101008957207Q00000X
AZ006228207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ626754Medicaid