Healthcare Provider Details

I. General information

NPI: 1972581296
Provider Name (Legal Business Name): RAQUEL NEELEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 HIGHWAY 187
HATCH NM
87937-7001
US

IV. Provider business mailing address

PO BOX 370
HATCH NM
87937-0370
US

V. Phone/Fax

Practice location:
  • Phone: 575-267-3280
  • Fax: 575-267-1747
Mailing address:
  • Phone: 505-267-3088
  • Fax: 505-267-1747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2005-0037
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: