Provider Demographics
NPI:1033248208
Name:MCCLYMONT, NEIL (DO)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:
Last Name:MCCLYMONT
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 1:2100 POWELL ST
Mailing Address - Street 2:SUITE 920
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1826
Mailing Address - Country:US
Mailing Address - Phone:510-350-2600
Mailing Address - Fax:510-879-9100
Practice Address - Street 1:4500 MEMORIAL DR
Practice Address - Street 2:MEMORIAL HOSPITAL - ER
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5360
Practice Address - Country:US
Practice Address - Phone:618-233-7750
Practice Address - Fax:618-257-6860
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2201207P00000X
IADO-05564207P00000X
CA20A18682207P00000X
IL036.117348207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036117348-8Medicaid
MO1033248208Medicaid
MO1033248208Medicaid