MEDICARE: JAMES G. NEAL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	R1C12	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023014669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES G. NEAL MD

Provider Business Mailing Address
First Line	:	105 S RIDGECREST AVE
Second Line	:
City	:	NIXA
State	:	MO
Zip	:	65714-7807
Country	:	US
Telephone Number	:	417-725-8250
Fax Number	:	417-724-3084

Provider Business Practice Location Address
First Line	:	105 S RIDGECREST AVE
Second Line	:
City	:	NIXA
State	:	MO
Zip	:	65714-7807
Country	:	US
Telephone Number	:	417-725-8250
Fax Number	:	417-724-3084

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	02/01/2023

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