Provider Demographics
NPI:1912953050
Name:NEWMAN, KEITH D (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:D
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:SUITE 1205
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-692-8262
Mailing Address - Fax:214-696-4190
Practice Address - Street 1:618 CLARA BARTON BLVD
Practice Address - Street 2:STE 3
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5750
Practice Address - Country:US
Practice Address - Phone:972-494-6764
Practice Address - Fax:972-454-6893
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3359208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046166701Medicaid
TX340009195OtherRAILROAD MEDICARE
TX340009195OtherRAILROAD MEDICARE
TX8L1799Medicare PIN
TXF50625Medicare UPIN