Provider Demographics
NPI:1396770046
Name:NEWSOME, CARLTON MORRIS (MD)
Entity type:Individual
Prefix:DR
First Name:CARLTON
Middle Name:MORRIS
Last Name:NEWSOME
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 1:520 LESTER ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4434
Mailing Address - Country:US
Mailing Address - Phone:870-862-9026
Mailing Address - Fax:870-862-9028
Practice Address - Street 1:520 LESTER ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4434
Practice Address - Country:US
Practice Address - Phone:870-862-9026
Practice Address - Fax:870-862-9028
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN5685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR106137001Medicaid
AR53841Medicare ID - Type Unspecified