Healthcare Provider Details

I. General information

NPI: 1669174611
Provider Name (Legal Business Name): NEAL SCOTT KUCERA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13677 W MCDOWELL RD
GOODYEAR AZ
85395-2635
US

IV. Provider business mailing address

6010 W KRISTAL WAY
GLENDALE AZ
85308-7679
US

V. Phone/Fax

Practice location:
  • Phone: 623-848-5612
  • Fax:
Mailing address:
  • Phone: 218-348-7610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: