Provider Demographics
NPI:1437393931
Name:SMALL, NEAL CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:CHARLES
Last Name:SMALL
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 1:2007 N COMMERCE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1268
Mailing Address - Country:US
Mailing Address - Phone:580-226-4599
Mailing Address - Fax:580-226-4599
Practice Address - Street 1:2007 N COMMERCE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1268
Practice Address - Country:US
Practice Address - Phone:580-226-4599
Practice Address - Fax:580-226-4599
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24271207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK24271OtherOKLAHOMA MEDICAL LICENSE
OKOKA100364Medicare PIN