Provider Demographics
NPI:1073584645
Name:NEEL, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:NEEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5658 W HIGHWAY 260
Mailing Address - Street 2:SUITE 19
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-5189
Mailing Address - Country:US
Mailing Address - Phone:928-532-5838
Mailing Address - Fax:928-532-6670
Practice Address - Street 1:5658 W HIGHWAY 260
Practice Address - Street 2:SUITE 19
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-5189
Practice Address - Country:US
Practice Address - Phone:928-532-5838
Practice Address - Fax:928-532-6670
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ7081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ285438Medicaid
AZAZ0325980OtherBLUE CROSS BLUE SHIELD AZ
AZ285438Medicaid
D00028Medicare UPIN