Provider Demographics
NPI:1265422281
Name:NEWTON, LETICEA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:LETICEA
Middle Name:MARIE
Last Name:NEWTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LETICEA
Other - Middle Name:MARIE
Other - Last Name:STEVENSON PABLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 751
Mailing Address - Street 2:
Mailing Address - City:HULBERT
Mailing Address - State:OK
Mailing Address - Zip Code:74441-0751
Mailing Address - Country:US
Mailing Address - Phone:918-772-3390
Mailing Address - Fax:918-683-0475
Practice Address - Street 1:1328 S YORK ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-7650
Practice Address - Country:US
Practice Address - Phone:918-683-0470
Practice Address - Fax:918-683-0475
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1121371Medicaid
OK21371OtherSTATE LICENSE NUMBER
OK1121371Medicaid