Healthcare Provider Details

I. General information

NPI: 1023014669
Provider Name (Legal Business Name): JAMES G. NEAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S RIDGECREST AVE
NIXA MO
65714-7807
US

IV. Provider business mailing address

105 S RIDGECREST AVE
NIXA MO
65714-7807
US

V. Phone/Fax

Practice location:
  • Phone: 417-725-8250
  • Fax: 417-724-3084
Mailing address:
  • Phone: 417-725-8250
  • Fax: 417-724-3084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR1C12
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: