Provider Demographics
NPI:1003839663
Name:MCNEEL, JACOB CAMERON (DO)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:CAMERON
Last Name:MCNEEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 STANAFORD RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3140
Mailing Address - Country:US
Mailing Address - Phone:304-465-1030
Mailing Address - Fax:304-469-9811
Practice Address - Street 1:250 STANAFORD ROAD
Practice Address - Street 2:STE 210
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3140
Practice Address - Country:US
Practice Address - Phone:304-254-2618
Practice Address - Fax:304-254-2669
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0046767000Medicaid
WV0046767000Medicaid
WVMC0806985Medicare PIN
WV0046767000Medicaid