Healthcare Provider Details

I. General information

NPI: 1124253893
Provider Name (Legal Business Name): JEFFREY ALLAN NEALE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2009
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13770 PLANTATION RD SUITE 2
FORT MYERS FL
33912-4301
US

IV. Provider business mailing address

2234 COLONIAL BLVD ATTN: MANAGED CARE DEPT.
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 239-275-0728
  • Fax: 239-275-6947
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT185247
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME107209
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: