Basic Information
Provider Information
NPI: 1750366464
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NEWMAN
FirstName: FOREST
MiddleName: PIKE
NamePrefix: DR.
NameSuffix: III
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9127 WINDGARDEN
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782391950
CountryCode: US
TelephoneNumber: 2103915615
FaxNumber: 2105907506
Practice Location
Address1: 3851 ROGER BROOKE DR
Address2: MCHE-QD (CREDS)
City: FORT SAM HOUSTON
State: TX
PostalCode: 782344501
CountryCode: US
TelephoneNumber: 2109163912
FaxNumber: 2109162077
Other Information
ProviderEnumerationDate: 12/14/2005
LastUpdateDate: 07/19/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RE0101XD0028896MDY Allopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism

No ID Information.


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