Provider Demographics
NPI:1568673689
Name:NEWMAN, FARRAH D (M D)
Entity type:Individual
Prefix:
First Name:FARRAH
Middle Name:D
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 N STATE ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2413
Mailing Address - Country:US
Mailing Address - Phone:601-353-2020
Mailing Address - Fax:601-714-5110
Practice Address - Street 1:1190 N STATE ST
Practice Address - Street 2:SUITE 403
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2413
Practice Address - Country:US
Practice Address - Phone:601-353-2020
Practice Address - Fax:601-714-5110
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS20070207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC02972OtherMEDICARE GROUP PTAN
MSP00812877OtherRAILROAD MEDICARE
MS02838545Medicaid
LA2135171Medicaid
MS258637YK0CMedicare PIN