Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | E8757 | TX |
NPI | 1265431415 |
---|---|
Provider Name | Dr. Samuel R Neeley |
First Address | San Antonio, TX 78216-2530 |
Second Address | San Antonio, TX 78216-2517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 19/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
120344004 | (05) | TX |
C19809 | (02) | TX |