Provider Demographics
NPI:1427156637
Name:NEWMAN, TROY MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:MICHAEL
Last Name:NEWMAN
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 1:1501 LAKELAND DR STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4869
Mailing Address - Country:US
Mailing Address - Phone:601-355-1085
Mailing Address - Fax:601-984-5042
Practice Address - Street 1:1200 N STATE ST
Practice Address - Street 2:SUITE 330
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2000
Practice Address - Country:US
Practice Address - Phone:601-353-2020
Practice Address - Fax:601-714-5110
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18981207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51105809OtherBCBS OF AL
MS04106554Medicaid
AL118619Medicaid
P00412425OtherMEDICARE RAILROAD
MS$$$$$$$$$OtherBLUE CROSS BLUE SHIELD OF MS
MS04106554Medicaid
AL102I180310Medicare PIN