Provider Demographics
NPI:1124077334
Name:COUTINHO, NEWTON BASIL (MD)
Entity type:Individual
Prefix:DR
First Name:NEWTON
Middle Name:BASIL
Last Name:COUTINHO
Suffix:
Gender:M
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:PO BOX 6011
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-6011
Mailing Address - Country:US
Mailing Address - Phone:406-541-1400
Mailing Address - Fax:406-541-1401
Practice Address - Street 1:2419 MULLAN RD STE A
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1856
Practice Address - Country:US
Practice Address - Phone:406-541-1400
Practice Address - Fax:406-541-1401
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9628207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1124077334Medicaid
P000061297OtherRAILROAD MEDICARE
MT97286OtherBCBSMT
MT1124077334OtherTRICARE
ID1129013OtherIDAHO MEDICARE
MT1013115856Medicare PIN
ID1129013OtherIDAHO MEDICARE