Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 1467 | WV |
NPI | 1003839663 |
---|---|
Provider Name | Jacob Cameron Mcneel |
First Address | Beckley, WV 25801-3140 |
Second Address | Beckley, WV 25801-3140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 27/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0046767000 | (05) | WV |
G22090 | (02) |