Provider Demographics
NPI:1447474390
Name:NEWTON, TEREL S (MD)
Entity type:Individual
Prefix:
First Name:TEREL
Middle Name:S
Last Name:NEWTON
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 3123
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-3123
Mailing Address - Country:US
Mailing Address - Phone:904-374-0353
Mailing Address - Fax:904-503-0982
Practice Address - Street 1:10175 FORTUNE PKWY UNIT 803
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6754
Practice Address - Country:US
Practice Address - Phone:904-374-0353
Practice Address - Fax:904-503-0982
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109638207LP2900X, 207LA0401X, 208VP0014X
NC2011-00093207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004C5OtherBCBS
FLFA345ZOtherMEDICARE PTAN
FL004C5OtherBCBS