Provider Demographics
NPI:1215229992
Name:NEIL F HADDOCK MD PA
Entity Type:Organization
Organization Name:NEIL F HADDOCK MD PA
Other - Org Name:SONTERRA DERMATOLOGY PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:HADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-496-5792
Mailing Address - Street 1:325 E SONTERRA BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4055
Mailing Address - Country:US
Mailing Address - Phone:210-496-5792
Mailing Address - Fax:
Practice Address - Street 1:325 E SONTERRA BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4055
Practice Address - Country:US
Practice Address - Phone:210-496-5792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9519174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty