Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080N0001X | Neonatal-Perinatal Doctor | ME42473 | FL |
Y | 208D00000X | General Practice Physician | ME42473 | FL |
NPI | 1063573855 |
---|---|
Provider Name | Dr. Mary Newport |
First Address | Spring Hill, FL 34610-7684 |
Second Address | Spring Hill, FL 34610-7684 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 11/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
068902500 | (05) | FL |
D63154 | (02) | FL |