Provider Demographics
NPI:1508242991
Name:MCLAUGHLIN, NEIL
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:MCLAUGHLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 106 S R 13 N
Mailing Address - Street 2:#443
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259
Mailing Address - Country:US
Mailing Address - Phone:904-294-6583
Mailing Address - Fax:904-230-2588
Practice Address - Street 1:450 106 S R 13 N
Practice Address - Street 2:#443
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259
Practice Address - Country:US
Practice Address - Phone:904-294-6583
Practice Address - Fax:904-230-2588
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL383743954171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications