Provider Demographics
NPI:1235104654
Name:NEWMAN, JAMES J (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52110
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79159-2110
Mailing Address - Country:US
Mailing Address - Phone:888-204-0379
Mailing Address - Fax:614-581-2274
Practice Address - Street 1:1200 E PECAN ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-6141
Practice Address - Country:US
Practice Address - Phone:580-931-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK185702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123269001Medicaid
MO201593407Medicaid
MOP00377096OtherMEDICARE RAILROAD
OK100257450AMedicaid
TXP00432729OtherMEDICARE RAILROAD
OKP00343240OtherMEDICARE RAILROAD
AR123269001Medicaid
OK243631703Medicare PIN
MO201593407Medicaid
KSR82E801Medicare PIN
MO961654868Medicare PIN
OK700047Medicare PIN