Basic Information
| Provider Information | |||||||||
| NPI: | 1578569091 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEIL | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 N 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | ELDRIDGE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527481113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5634219880 | ||||||||
| FaxNumber: | 5634219919 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 N 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | ELDRIDGE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527481113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5632857232 | ||||||||
| FaxNumber: | 5632856742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2005 | ||||||||
| LastUpdateDate: | 03/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34192 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1214015 | 05 | IA | MEDICAID | IA01J6 | 01 | JOHN DEERE HEALTH PLAN | OTHER | 34843 | 01 | WELLMARK BC/BS | OTHER | 208141 | 01 | IOWA HEALTH SOLUTIONS | OTHER | 085492 | 01 | HEALTH ALLIANCE | OTHER | 4796890010 | 01 | DMERC | OTHER |