Basic Information
| Provider Information | |||||||||
| NPI: | 1376896324 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEWSOM COSMETICS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13904 N DALE MABRY HWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336182446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139082020 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13904 N DALE MABRY HWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336182446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139082020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2012 | ||||||||
| LastUpdateDate: | 10/16/2012 | ||||||||
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| AuthorizedOfficialLastName: | NEWSOM | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | MGRM | ||||||||
| AuthorizedOfficialTelephone: | 8139082020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery | 2082S0099X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery | Plastic Surgery Within the Head and Neck | 207W00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.