Healthcare Provider Details

I. General information

NPI: 1598749954
Provider Name (Legal Business Name): NEAL NEUMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HEALTH WAY DR
POTOSI MO
63664-1420
US

IV. Provider business mailing address

300 HEALTH WAY DR
POTOSI MO
63664-1420
US

V. Phone/Fax

Practice location:
  • Phone: 573-438-2977
  • Fax: 573-438-1252
Mailing address:
  • Phone: 573-438-2977
  • Fax: 573-438-1252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number036-052282
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number33428
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: