Provider Demographics
NPI:1205812898
Name:MCNEILL, JOHN LEE (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LEE
Last Name:MCNEILL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 SAM HOUSTON DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2682
Mailing Address - Country:US
Mailing Address - Phone:361-578-5730
Mailing Address - Fax:361-578-0749
Practice Address - Street 1:3002 SAM HOUSTON DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2682
Practice Address - Country:US
Practice Address - Phone:361-578-5730
Practice Address - Fax:361-578-0749
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5623207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139635007Medicaid
TXDH0924OtherMEDICARE RR
TX0034ETOtherBCBS OF TX #
TX74-2964639OtherTAX ID #
TX00249GMedicare ID - Type Unspecified
TXDH0924OtherMEDICARE RR