Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 2004033406 | MO |
NPI | 1225042377 |
---|---|
Provider Name | Dr. Adam G. Newman |
First Address | Mountain Home, AR 72653-3654 |
Second Address | Mountain Home, AR 72653-3654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 11/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
# PENDING | (02) | MO |
# PENDING | (05) | MO |