Provider Demographics
NPI:1467143925
Name:PEREA-NEAL, STEPHANIE ADELE (DO)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ADELE
Last Name:PEREA-NEAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ADELE
Other - Last Name:NEAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:TTUHSC DEPARTMENT OF EMERGENCY MEDICINE
Mailing Address - Street 2:3601 4TH STREET - MS6211
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430
Mailing Address - Country:US
Mailing Address - Phone:806-761-0559
Mailing Address - Fax:
Practice Address - Street 1:TTUHSC DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - Street 2:3601 4TH STREET - MS6211
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430
Practice Address - Country:US
Practice Address - Phone:806-761-0559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10083610390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program