Provider Demographics
NPI:1982673091
Name:NEWLAND, DOUGLAS ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALAN
Last Name:NEWLAND
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 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13601 PLANTATION RD STE 3
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4437
Practice Address - Country:US
Practice Address - Phone:239-343-1290
Practice Address - Fax:239-343-0958
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00344362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274826600Medicaid
FL79453XMedicare PIN
FL274826600Medicaid
FL79453ZMedicare PIN