Healthcare Provider Details

I. General information

NPI: 1215469044
Provider Name (Legal Business Name): NEIL MARK D'SOUZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CHIMNEY CORNER LN STE 1011
JUPITER FL
33458-4804
US

IV. Provider business mailing address

PO BOX 910221
DALLAS TX
75391-0221
US

V. Phone/Fax

Practice location:
  • Phone: 561-275-1820
  • Fax:
Mailing address:
  • Phone: 520-519-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME170684
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: