1265422281 NPI number — DR. LETICEA MARIE NEWTON MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265422281 NPI number — DR. LETICEA MARIE NEWTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWTON
Provider First Name:
LETICEA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEVENSON PABLO
Provider Other First Name:
LETICEA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265422281
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 751
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HULBERT
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74441-0751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-772-3390
Provider Business Mailing Address Fax Number:
918-683-0475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1328 S YORK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUSKOGEE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74403-7650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-683-0470
Provider Business Practice Location Address Fax Number:
918-683-0475
Provider Enumeration Date:
10/21/2005

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: 207Q00000X , with the licence number:  21371 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1121371 , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21371 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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