Healthcare Provider Details

I. General information

NPI: 1043751928
Provider Name (Legal Business Name): EDDIE NEAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1557 SPRING HILL AVE SUITE A
MOBILE AL
36604-3218
US

IV. Provider business mailing address

1557 SPRING HILL AVE SUITE A
MOBILE AL
36604-3218
US

V. Phone/Fax

Practice location:
  • Phone: 251-433-0400
  • Fax: 251-433-9940
Mailing address:
  • Phone: 251-433-0400
  • Fax: 251-433-9940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number38
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: