Basic Information
| Provider Information | |||||||||
| NPI: | 1598934374 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHN W NEAL V MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 519 E LAUCHWOOD DR | ||||||||
| Address2: | |||||||||
| City: | LAURINBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283525502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102761150 | ||||||||
| FaxNumber: | 9102771966 | ||||||||
| Practice Location | |||||||||
| Address1: | 519 E LAUCHWOOD DR | ||||||||
| Address2: | |||||||||
| City: | LAURINBURG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283525502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102761150 | ||||||||
| FaxNumber: | 9102771966 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2008 | ||||||||
| LastUpdateDate: | 02/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | NEAL | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9102761150 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | V | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 22313 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8961923 | 05 | NC | MEDICAID |