| Organization Name: | MARK A. NEWBERRY |
| NPI Number: | 1851539050 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK A. NEWBERRY (OWNER) |
| Mailing Address: | 602 E 5th Ave Havana |
| State: | FL US |
| Postal Code: | 323331442 |
| Phone Number: | 8505394747 |
| Fax Number: | 8505394744 |
| NPI Enumeration Date: | 01/26/2009 |
| NPI Last Update Date: | 06/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | ME55545 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |