Healthcare Provider Details

I. General information

NPI: 1811945264
Provider Name (Legal Business Name): DAVID L NEIGHBORS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 HOLY CROSS LN
BREESE IL
62230-3510
US

IV. Provider business mailing address

9401 HOLY CROSS LN
BREESE IL
62230-3510
US

V. Phone/Fax

Practice location:
  • Phone: 618-526-7271
  • Fax: 618-526-7313
Mailing address:
  • Phone: 618-526-7271
  • Fax: 618-526-7313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number036071499
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number036071499
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number036071499
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: