Provider Demographics
NPI:1225099054
Name:NEVILLE, THOMAS M (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:NEVILLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-1011
Mailing Address - Country:US
Mailing Address - Phone:970-350-4606
Mailing Address - Fax:970-350-4645
Practice Address - Street 1:302 3RD ST SE
Practice Address - Street 2:SUITE 150
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-6419
Practice Address - Country:US
Practice Address - Phone:970-669-4855
Practice Address - Fax:970-669-7389
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044664207Q00000X
CO54244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0424615Medicaid
CO34159002Medicaid
OHNE0476042Medicare PIN
OH0424615Medicaid