MEDICARE: DONALD EDWIN NEAL 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	207N00000X	Dermatology Physician	0074480	CO
2	207N00000X	Dermatology Physician	1017036	MA
3	207N00000X	Dermatology Physician	67652	MN
4	207R00000X	Internal Medicine Physician	MT218467	PA
5	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	67652	MN

General Provider Information

NPI Number	:	1952960411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD EDWIN NEAL MD

Provider Business Mailing Address
First Line	:	4440 ARAPAHOE AVE STE 200
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80303-9101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4440 ARAPAHOE AVE STE 200
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80303-9101
Country	:	US
Telephone Number	:	720-686-7546
Fax Number	:

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

Provider Enumeration Date	:	06/10/2019
Last Update Date	:	11/17/2025

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