Provider Demographics
NPI:1124392683
Name:NEIL L. HALIM, MD INC.
Entity Type:Organization
Organization Name:NEIL L. HALIM, MD INC.
Other - Org Name:LAKE SAN MARCOS FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-230-5487
Mailing Address - Street 1:1030 LA BONITA DR
Mailing Address - Street 2:SUITE 316
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-5291
Mailing Address - Country:US
Mailing Address - Phone:760-744-9626
Mailing Address - Fax:760-744-0751
Practice Address - Street 1:1030 LA BONITA DR
Practice Address - Street 2:SUITE 316
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-5291
Practice Address - Country:US
Practice Address - Phone:760-744-9626
Practice Address - Fax:760-744-0751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53327207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty