Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 036144051 | IL |
Y | 213ES0000X | Sports Medicine | 036144051 | IL |
NPI | 1164783619 |
---|---|
Provider Name | James Patrick Newman |
First Address | Springfield, IL 62703-2403 |
Second Address | Springfield, IL 62702-3719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2012 |
Last Update Date | 21/05/2020 |