Provider Demographics
NPI:1205917671
Name:NEWBERRY, WILLIAM E (PA-C)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:E
Last Name:NEWBERRY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:E
Other - Last Name:NEWBERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:247 N FIREWEED ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7540
Mailing Address - Country:US
Mailing Address - Phone:907-262-8597
Mailing Address - Fax:907-262-6516
Practice Address - Street 1:247 N FIREWEED ST
Practice Address - Street 2:SUITE A
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7540
Practice Address - Country:US
Practice Address - Phone:907-262-8597
Practice Address - Fax:907-262-6516
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK147363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK0147OtherPHYSICIAN ASSIST LICENSE
AKP00806322OtherRAILROAD MEDICARE
AKMDA0269Medicaid
AKMN0341191OtherDEA
AKMN0341191OtherDEA