Provider Demographics
NPI:1003877648
Name:NEWMAN, TIMOTHY WILLIAM I (INDEPENDENT DUTY COR)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:WILLIAM
Last Name:NEWMAN
Suffix:I
Gender:M
Credentials:INDEPENDENT DUTY COR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10353 SAN DIEGO MISSION RD
Mailing Address - Street 2:APT C219
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2136
Mailing Address - Country:US
Mailing Address - Phone:619-886-1454
Mailing Address - Fax:
Practice Address - Street 1:10353 SAN DIEGO MISSION RD
Practice Address - Street 2:APT C219
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2136
Practice Address - Country:US
Practice Address - Phone:619-886-1454
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman