Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ME0048593 | FL |
Y | 208600000X | Surgeon | ME0048593 | FL |
N | 2086S0129X | Vascular Surgeon | ME0048593 | FL |
NPI | 1063407104 |
---|---|
Provider Name | Dr. John Neal |
First Address | Tallahassee, FL 32308-4408 |
Second Address | Tallahassee, FL 32308-4408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 01/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D85390 | (02) | FL |