Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH0003725 | FL |
NPI | 1023033453 |
---|---|
Provider Name | Charles B. Neal |
First Address | Pensacola, FL 32504-7343 |
Second Address | Pensacola, FL 32504-7343 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 17/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
593484706 | TAX ID (01) | FL |
CH0003725 | STATE LICENSE (01) | FL |
T55989 | (02) | FL |