Provider Demographics
NPI:1871753764
Name:NEWMAN, STACY R (MD)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:R
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2195
Mailing Address - Country:US
Mailing Address - Phone:541-269-0333
Mailing Address - Fax:541-269-7389
Practice Address - Street 1:1750 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2195
Practice Address - Country:US
Practice Address - Phone:541-269-0333
Practice Address - Fax:541-269-7389
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.204781207R00000X, 207RI0200X
ORMD213598207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500820030Medicaid
LA1106917Medicaid