Healthcare Provider Details

I. General information

NPI: 1194370536
Provider Name (Legal Business Name): DUKE NEAL MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 PROFESSIONAL DR
HOUMA LA
70360-4046
US

IV. Provider business mailing address

12 PROFESSIONAL DR
HOUMA LA
70360-4046
US

V. Phone/Fax

Practice location:
  • Phone: 985-868-1810
  • Fax: 985-876-3670
Mailing address:
  • Phone: 985-868-1810
  • Fax: 985-876-3670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PHILIP MARK NEAL
Title or Position: MANAGER, MEMBER
Credential: MD
Phone: 985-868-1810