Provider Demographics
NPI:1164791091
Name:NEELY, ROBERT (HIS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:NEELY
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 N LOY LAKE RD STE H
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2837
Mailing Address - Country:US
Mailing Address - Phone:903-482-4018
Mailing Address - Fax:580-745-5173
Practice Address - Street 1:2001 N LOY LAKE RD STE H
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2837
Practice Address - Country:US
Practice Address - Phone:903-482-4018
Practice Address - Fax:580-745-5173
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK996237700000X
TX80264237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist