Provider Demographics
NPI:1952395196
Name:NEWELL, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:NEWELL
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 1:1234 DAVID DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1300
Mailing Address - Country:US
Mailing Address - Phone:985-384-2430
Mailing Address - Fax:985-384-2473
Practice Address - Street 1:1234 DAVID DR
Practice Address - Street 2:SUITE A
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1300
Practice Address - Country:US
Practice Address - Phone:985-384-2430
Practice Address - Fax:985-384-2473
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06766R2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1350567Medicaid
B62134Medicare UPIN
50005Medicare ID - Type Unspecified