Provider Demographics
NPI:1740458512
Name:WILLIAM C NEWBERRY MD PA
Entity type:Organization
Organization Name:WILLIAM C NEWBERRY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-853-7319
Mailing Address - Street 1:3301 S ALAMEDA ST
Mailing Address - Street 2:SUITE #403
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1882
Mailing Address - Country:US
Mailing Address - Phone:361-853-7319
Mailing Address - Fax:361-853-1641
Practice Address - Street 1:3301 S ALAMEDA ST
Practice Address - Street 2:SUITE #403
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1882
Practice Address - Country:US
Practice Address - Phone:361-853-7319
Practice Address - Fax:361-853-1641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0497207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000R66V8Medicaid
TX00R66VMedicare PIN
TXB25143Medicare UPIN