Healthcare Provider Details

I. General information

NPI: 1679006522
Provider Name (Legal Business Name): BRETT NEILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 S NATIONAL AVE STE 705
SPRINGFIELD MO
65807-5239
US

IV. Provider business mailing address

3850 S NATIONAL AVE STE 705
SPRINGFIELD MO
65807-5239
US

V. Phone/Fax

Practice location:
  • Phone: 417-888-0858
  • Fax:
Mailing address:
  • Phone: 417-888-0858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberS9944
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD209893
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number2019031589
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number2019031589
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: