Provider Demographics
NPI:1033675277
Name:FOUKE, NEAL HODGES
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:HODGES
Last Name:FOUKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-2032
Mailing Address - Country:US
Mailing Address - Phone:541-748-9650
Mailing Address - Fax:541-615-9306
Practice Address - Street 1:25 N 4TH ST
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2032
Practice Address - Country:US
Practice Address - Phone:541-748-9650
Practice Address - Fax:541-615-9306
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111826363A00000X
ORPA191679363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9111826OtherPHYSICIAN ASSISTANT