Healthcare Provider Details

I. General information

NPI: 1285899948
Provider Name (Legal Business Name): TIMOTHY SCOTT NEAVIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9615 BRIGHTON WAY SUITE 303
BEVERLY HILLS CA
90210-5131
US

IV. Provider business mailing address

9615 BRIGHTON WAY SUITE 303
BEVERLY HILLS CA
90210-5131
US

V. Phone/Fax

Practice location:
  • Phone: 310-858-8811
  • Fax: 310-858-8282
Mailing address:
  • Phone: 310-858-8811
  • Fax: 310-858-8282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA99678
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: