1053407387 NPI number — MR. DONALD BRYANT NEWLIN PHYSICIAN ASSISTANT

Table of content: MR. DONALD BRYANT NEWLIN PHYSICIAN ASSISTANT (NPI 1053407387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053407387 NPI number — MR. DONALD BRYANT NEWLIN PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWLIN
Provider First Name:
DONALD
Provider Middle Name:
BRYANT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053407387
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6820 48TH AVE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98443-2309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-809-5354
Provider Business Mailing Address Fax Number:
253-968-0920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MADIGAN ARMY MEDICAL CTR, 9040 JACKSON AVE
Provider Second Line Business Practice Location Address:
ATTN: WENDY MCKINNEY 253-968-2252 CREDENTIALS OFFICE
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98431-1100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-968-2704
Provider Business Practice Location Address Fax Number:
253-968-0920
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA10004297 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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