Provider Demographics
NPI:1023014669
Name:NEAL, JAMES G (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:NEAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:105 S RIDGECREST AVE
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-7807
Mailing Address - Country:US
Mailing Address - Phone:417-725-8250
Mailing Address - Fax:417-724-3084
Practice Address - Street 1:105 S RIDGECREST AVE
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-7807
Practice Address - Country:US
Practice Address - Phone:417-725-8250
Practice Address - Fax:417-724-3084
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR1C122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202584645Medicaid
MO1023014669Medicaid
MO1023014669Medicaid
MO051010453Medicare ID - Type Unspecified