MEDICARE: DR. NEAL THOMAS DECOSTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	104301	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023097524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEAL THOMAS DECOSTA MD

Provider Business Mailing Address
First Line	:	501 GLADES RD
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33432-1419
Country	:	US
Telephone Number	:	561-939-5500
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 S ELM AVE
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-3845
Country	:	US
Telephone Number	:	314-962-3464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	05/22/2013

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