1669444337 NPI number — DR. DAVID BLAIR NEELAND M.D.

Table of content: AMANI ROSE MEDLOCK (NPI 1932774270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669444337 NPI number — DR. DAVID BLAIR NEELAND M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEELAND
Provider First Name:
DAVID
Provider Middle Name:
BLAIR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669444337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2055 NORMANDIE DR
Provider Second Line Business Mailing Address:
108
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36111-2732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-288-4624
Provider Business Mailing Address Fax Number:
334-280-3628

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2055 NORMANDIE DR
Provider Second Line Business Practice Location Address:
108
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36111-2732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-288-4624
Provider Business Practice Location Address Fax Number:
334-280-3628
Provider Enumeration Date:
02/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  00007989 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: ME90164 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 0000-20942 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000058866 . This is a "IDTF" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009968475 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009945290 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009968495 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107019 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000045292 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107018 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000045290 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051504364 . This is a "IDTF" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009968485 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108194 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000058867 . This is a "IDTF" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000085896 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 270024700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000083515 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009965385 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009974205 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108460 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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