Basic Information
| Provider Information | |||||||||
| NPI: | 1760667802 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHN LEE MCNEILL, DO, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4348 | ||||||||
| Address2: | |||||||||
| City: | VICTORIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779034348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3615763680 | ||||||||
| FaxNumber: | 3615780749 | ||||||||
| Practice Location | |||||||||
| Address1: | 3002 SAM HOUSTON DR. | ||||||||
| Address2: | |||||||||
| City: | VICTORIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3615783363 | ||||||||
| FaxNumber: | 3615780749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2008 | ||||||||
| LastUpdateDate: | 11/14/2012 | ||||||||
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| AuthorizedOfficialLastName: | MCNEILL | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3615763680 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.