Provider Demographics
NPI:1063909737
Name:NEWBY, NORWYN ROBERT
Entity type:Individual
Prefix:DR
First Name:NORWYN
Middle Name:ROBERT
Last Name:NEWBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3054 NW DUFFY DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-5485
Mailing Address - Country:US
Mailing Address - Phone:541-410-3612
Mailing Address - Fax:
Practice Address - Street 1:3054 NW DUFFY DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-5485
Practice Address - Country:US
Practice Address - Phone:541-410-3612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD12478207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD12478OtherMEDICAL LICENSE