Basic Information
| Provider Information | |||||||||
| NPI: | 1518946870 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCNEILL | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | HUGH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7809 JEFFERSON HWY STE B2 | ||||||||
| Address2: | STE B2 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708091200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259268686 | ||||||||
| FaxNumber: | 2259268677 | ||||||||
| Practice Location | |||||||||
| Address1: | 5000 HENNESSY BLVD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259268686 | ||||||||
| FaxNumber: | 2259268677 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2006 | ||||||||
| LastUpdateDate: | 08/23/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 06272R | LA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1341886 | 05 | LA | MEDICAID |