Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 404 | ND |
NPI | 1649219924 |
---|---|
Provider Name | Dr. Scott L Newgard |
First Address | Mandan, ND 58554-3140 |
Second Address | Mandan, ND 58554-3140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
15837 | (05) | ND |
T66793 | (02) | ND |