Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | MD12478 | OR |
NPI | 1063909737 |
---|---|
Provider Name | Dr. Norwyn Robert Newby |
First Address | Bend, OR 97703-5485 |
Second Address | Bend, OR 97703-5485 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2018 |
Last Update Date | 18/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MD12478 | MEDICAL LICENSE (01) | OR |