1649631193 NPI number — DR. BRIAN W NEWMAN DO

Table of content: DR. BRIAN W NEWMAN DO (NPI 1649631193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649631193 NPI number — DR. BRIAN W NEWMAN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWMAN
Provider First Name:
BRIAN
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1649631193
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
264 COUNTY ROAD 1130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLOW SPRINGS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65793-3305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-802-1001
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4643 WAIMEA CANYON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAIMEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96796
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-338-9431
Provider Business Practice Location Address Fax Number:
83-389-2108
Provider Enumeration Date:
03/11/2016

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: 207R00000X , with the licence number:  DOS-2397 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208M00000X , with the licence number: 134052 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: BP10053707 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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