Healthcare Provider Details

I. General information

NPI: 1033224431
Provider Name (Legal Business Name): ROBERT MACNEAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 N DAVIS HWY
PENSACOLA FL
32514-6050
US

IV. Provider business mailing address

8333 N DAVIS HWY
PENSACOLA FL
32514-6050
US

V. Phone/Fax

Practice location:
  • Phone: 850-474-8386
  • Fax: 850-474-8522
Mailing address:
  • Phone: 850-474-8100
  • Fax: 850-474-8083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number37789
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number37789
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number12238
License Number StateNH
# 4
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number018570
License Number StateME
# 5
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number12238
License Number StateNH
# 6
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number37789
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: