Provider Demographics
NPI:1679100895
Name:NEWTON, DAMON LAMONT
Entity type:Individual
Prefix:MR
First Name:DAMON
Middle Name:LAMONT
Last Name:NEWTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9508 E 57TH ST
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-3205
Mailing Address - Country:US
Mailing Address - Phone:816-352-8011
Mailing Address - Fax:816-356-1383
Practice Address - Street 1:9508 E 57TH ST
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-3205
Practice Address - Country:US
Practice Address - Phone:816-352-8011
Practice Address - Fax:816-356-1383
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOU213206024172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver