Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 7951 | KY |
Y | 1223G0001X | General Practice | 7951 | KY |
Y | 213EG0000X | General Practice | 7951 | KY |
NPI | 1003021957 |
---|---|
Provider Name | Dr. Eddy Joe Newberry II |
First Address | Glasgow, KY 42141-7873 |
Second Address | Glasgow, KY 42141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 11/05/2011 |