Provider Demographics
NPI:1104180728
Name:P MARK NEAL MD LLC
Entity Type:Organization
Organization Name:P MARK NEAL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:P
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-868-1810
Mailing Address - Street 1:12 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4046
Mailing Address - Country:US
Mailing Address - Phone:985-868-1810
Mailing Address - Fax:985-876-3670
Practice Address - Street 1:12 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4046
Practice Address - Country:US
Practice Address - Phone:985-868-1810
Practice Address - Fax:985-876-3670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202640174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty