Provider Demographics
NPI:1225665516
Name:NEAL, JOHN A (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:NEAL
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 1:1701 W CHARLESTON BLVD STE 670
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2343
Mailing Address - Country:US
Mailing Address - Phone:702-780-7588
Mailing Address - Fax:702-671-2233
Practice Address - Street 1:1701 W CHARLESTON BLVD STE 670
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2343
Practice Address - Country:US
Practice Address - Phone:702-780-7588
Practice Address - Fax:702-671-2233
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A22350208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program