Healthcare Provider Details

I. General information

NPI: 1710079066
Provider Name (Legal Business Name): DOUGLAS M MCNEAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E BRADFORD PKWY BLDG B
SPRINGFIELD MO
65804-4264
US

IV. Provider business mailing address

PO BOX 844715
KANSAS CITY MO
64184-4715
US

V. Phone/Fax

Practice location:
  • Phone: 417-761-5000
  • Fax:
Mailing address:
  • Phone: 417-761-5000
  • Fax: 417-761-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License NumberR3B74
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: