Provider Demographics
NPI:1073551081
Name:MACNEAL, NANCY JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:JEAN
Last Name:MACNEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2924 SW BUCHAREST CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-3163
Mailing Address - Country:US
Mailing Address - Phone:503-297-2606
Mailing Address - Fax:503-296-6841
Practice Address - Street 1:9155 SW BARNES RD
Practice Address - Street 2:SUITE 340
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6625
Practice Address - Country:US
Practice Address - Phone:503-297-3751
Practice Address - Fax:503-296-6832
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD16316207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORA06664Medicare UPIN