Healthcare Provider Details

I. General information

NPI: 1750608592
Provider Name (Legal Business Name): GWENDOLYN NEEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY DEPARTMENT OF OB/GYN
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

825 NE 10TH ST
OKLAHOMA CITY OK
73104-5417
US

V. Phone/Fax

Practice location:
  • Phone: 318-675-8295
  • Fax: 318-675-4671
Mailing address:
  • Phone: 405-271-9494
  • Fax: 405-271-3727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number31336
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: