Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 35-083650 | OH |
Y | 207SG0201X | Clinical Genetics (M.D.) | 56355 | AZ |
NPI | 1548293822 |
---|---|
Provider Name | Derek E Neilson |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 10/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000224312 | UNISON (01) | OH |
000000340115 | ANTHEM (01) | OH |
000000529594 | ANTHEM (01) | OH |
2499952 | (05) | OH |
363878 | WELLCARE (01) | OH |
745996 | BUCKEYE (01) | OH |
7841606 | AETNA (01) | OH |
I16974 | (02) | OH |