Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 12232 | CA |
NPI | 1003941238 |
---|---|
Provider Name | Dr. Carl R Neeley |
First Address | Rocklin, CA 95677-3100 |
Second Address | Rocklin, CA 95677-3100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 08/07/2007 |