Healthcare Provider Details

I. General information

NPI: 1215983788
Provider Name (Legal Business Name): THOMAS F. NEAL, M.D., STAN E. POTOCKI, M.D., PROFESSIONAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 22ND ST STE 300
LUBBOCK TX
79410-1301
US

IV. Provider business mailing address

3621 22ND ST STE 300
LUBBOCK TX
79410-1301
US

V. Phone/Fax

Practice location:
  • Phone: 806-792-5331
  • Fax: 806-792-9417
Mailing address:
  • Phone: 806-792-5331
  • Fax: 806-792-9417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: STAN E POTOCKI
Title or Position: OWNER
Credential: M.D.
Phone: 806-792-5331