Healthcare Provider Details

I. General information

NPI: 1861843344
Provider Name (Legal Business Name): JAMES J NEITZEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR DEPARTMENT OF EMERGENCY MEDICINE
COLUMBIA MO
65212-1000
US

IV. Provider business mailing address

1 HOSPITAL DR DEPARTMENT OF EMERGENCY MEDICINE
COLUMBIA MO
65212-1000
US

V. Phone/Fax

Practice location:
  • Phone: 573-884-3233
  • Fax: 573-884-5994
Mailing address:
  • Phone: 573-884-3233
  • Fax: 573-884-5994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2016022157
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: