Provider Demographics
NPI:1558310789
Name:NEELY, PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:NEELY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:152 INTRACOASTAL DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9424
Mailing Address - Country:US
Mailing Address - Phone:256-217-0334
Mailing Address - Fax:256-864-2668
Practice Address - Street 1:1 METROPLEX DR
Practice Address - Street 2:SUITE 250
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6893
Practice Address - Country:US
Practice Address - Phone:205-802-7725
Practice Address - Fax:205-802-7549
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL134182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL18143Medicaid
ALC79060Medicare UPIN
AL18143Medicaid