Healthcare Provider Details

I. General information

NPI: 1851654420
Provider Name (Legal Business Name): BRIAN S NEELY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 09/23/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29475 W 189TH TER
GARDNER KS
66030-9428
US

IV. Provider business mailing address

401 S WASHINGTON AVE
IOLA KS
66749-3256
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-1227
  • Fax:
Mailing address:
  • Phone: 620-365-6933
  • Fax: 620-365-8126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-38154
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: