Healthcare Provider Details

I. General information

NPI: 1487249462
Provider Name (Legal Business Name): ALVIN L NEAL JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 NICKLAUS DR
SLIDELL LA
70458-8847
US

IV. Provider business mailing address

277 NICKLAUS DR
SLIDELL LA
70458-8847
US

V. Phone/Fax

Practice location:
  • Phone: 985-297-1105
  • Fax:
Mailing address:
  • Phone: 985-297-1105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: