Basic Information
| Provider Information | |||||||||
| NPI: | 1699739052 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HADDOCK | ||||||||
| FirstName: | NEIL | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 325 E SONTERRA BLVD | ||||||||
| Address2: | SUITE # 110 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782584054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104965792 | ||||||||
| FaxNumber: | 2104967601 | ||||||||
| Practice Location | |||||||||
| Address1: | 325 E SONTERRA BLVD | ||||||||
| Address2: | SUITE # 110 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782584054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104965792 | ||||||||
| FaxNumber: | 2104967601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2006 | ||||||||
| LastUpdateDate: | 01/03/2014 | ||||||||
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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 | 174400000X | F9519 | TX | Y | Other Service Providers | Specialist |
No ID Information.