MEDICARE: NEIL F. HADDOCK M.D.

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	174400000X	Specialist	F9519	TX

General Provider Information

NPI Number	:	1699739052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEIL F. HADDOCK M.D.

Provider Business Mailing Address
First Line	:	325 E SONTERRA BLVD
Second Line	:	SUITE # 110
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4054
Country	:	US
Telephone Number	:	210-496-5792
Fax Number	:	210-496-7601

Provider Business Practice Location Address
First Line	:	325 E SONTERRA BLVD
Second Line	:	SUITE # 110
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4054
Country	:	US
Telephone Number	:	210-496-5792
Fax Number	:	210-496-7601

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	01/03/2014

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