Healthcare Provider Details

I. General information

NPI: 1689036667
Provider Name (Legal Business Name): RICHARD NEESE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E WOOD ST
SPARTANBURG SC
29303-3040
US

IV. Provider business mailing address

PO BOX 2545
COLUMBUS GA
31902-2545
US

V. Phone/Fax

Practice location:
  • Phone: 864-560-6122
  • Fax: 864-560-6276
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number83992
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number056601
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: