Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 01070517A | IN |
N | 207P00000X | Emergency Physician | 036103527 | IL |
NPI | 1013133396 |
---|---|
Provider Name | Joseph Lee Newberg |
First Address | Lafayette, LA 70508-3870 |
Second Address | La Porte, IN 46350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 15/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036103527 | BLUE SHIELD (01) | IL |
G38213 | (02) |