Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | A94848 | CA |
NPI | 1508950213 |
---|---|
Provider Name | Dr. John Dodd Neely |
First Address | San Francisco, CA 94121-1563 |
Second Address | San Francisco, CA 94121-1563 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 03/01/2022 |