MEDICARE: NEIL DOCTOR

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	S7040	TX
2	208VP0014X	Interventional Pain Medicine Physician	S7040	TX

General Provider Information

NPI Number	:	1619322492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEIL DOCTOR

Provider Business Mailing Address
First Line	:	2817 W LOOP 250 N STE A
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79705-3205
Country	:	US
Telephone Number	:	432-218-8054
Fax Number	:	432-218-6487

Provider Business Practice Location Address
First Line	:	2817 W LOOP 250 N STE A
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79705-3205
Country	:	US
Telephone Number	:	432-218-8054
Fax Number	:	432-218-6487

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

Provider Enumeration Date	:	04/28/2016
Last Update Date	:	06/12/2023

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Directions to “ NEIL DOCTOR ” Practice Location

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