Basic Information
| Provider Information | |||||||||
| NPI: | 1942460738 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEELY | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | CHAMBERLAIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 W 40TH ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787564010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124598753 | ||||||||
| FaxNumber: | 5124836807 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 W 40TH ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124598753 | ||||||||
| FaxNumber: | 5124836807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2008 | ||||||||
| LastUpdateDate: | 07/27/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | R2930 | TX | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 372272001 | 05 | TX | MEDICAID |