Provider Demographics
NPI:1366497059
Name:NEAL, ERIC JON (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JON
Last Name:NEAL
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:PO BOX 5040
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966
Mailing Address - Country:US
Mailing Address - Phone:530-532-8584
Mailing Address - Fax:530-532-8433
Practice Address - Street 1:2809 OLIVE HIGHWAY
Practice Address - Street 2:SUITE #330
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966
Practice Address - Country:US
Practice Address - Phone:530-533-0774
Practice Address - Fax:530-533-3568
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79682208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G796820Medicaid
H18740Medicare UPIN
CA00G796822Medicare ID - Type Unspecified