Healthcare Provider Details

I. General information

NPI: 1073584645
Provider Name (Legal Business Name): DANIEL NEEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5658 W HIGHWAY 260 SUITE 19
LAKESIDE AZ
85929-5189
US

IV. Provider business mailing address

5658 W HIGHWAY 260 SUITE 19
LAKESIDE AZ
85929-5189
US

V. Phone/Fax

Practice location:
  • Phone: 928-532-5838
  • Fax: 928-532-6670
Mailing address:
  • Phone: 928-532-5838
  • Fax: 928-532-6670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7081
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: