MEDICARE: NATHANIEL NEAL

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	363AM0700X	Medical Physician Assistant	PA08634	TX

General Provider Information

NPI Number	:	1821427790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL NEAL

Provider Business Mailing Address
First Line	:	PO BOX 9101
Second Line	:	STE 600
City	:	COPPELL
State	:	TX
Zip	:	75019-9494
Country	:	US
Telephone Number	:	972-745-7500
Fax Number	:	972-471-0700

Provider Business Practice Location Address
First Line	:	7232 NORTH FWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-2481
Country	:	US
Telephone Number	:	817-439-8100
Fax Number	:	817-439-8103

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

Provider Enumeration Date	:	11/01/2013
Last Update Date	:	04/08/2016

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Directions to “ NATHANIEL NEAL ” Practice Location

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