Provider Demographics
NPI:1154436632
Name:NEWSOM, SHEILA G (MD)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:G
Last Name:NEWSOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 AQUA VERDE DR.
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-1017
Mailing Address - Country:US
Mailing Address - Phone:432-522-2304
Mailing Address - Fax:432-522-2307
Practice Address - Street 1:4200 W ILLINOIS AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-5692
Practice Address - Country:US
Practice Address - Phone:432-522-2304
Practice Address - Fax:432-522-2307
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5429207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1277998-06Medicaid
TX127799806Medicaid
P00199641OtherRAILROAD MEDICARE
TX1277998-06Medicaid
P00199641OtherRAILROAD MEDICARE