Provider Demographics
NPI:1568576155
Name:MCNEELY, PAUL DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DOUGLAS
Last Name:MCNEELY
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 1:17450 ST LUKES WAY
Mailing Address - Street 2:SUITE 340
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-8044
Mailing Address - Country:US
Mailing Address - Phone:936-266-2645
Mailing Address - Fax:936-266-8520
Practice Address - Street 1:17450 ST LUKES WAY
Practice Address - Street 2:SUITE 340
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8044
Practice Address - Country:US
Practice Address - Phone:936-266-2645
Practice Address - Fax:936-266-8520
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD023999207RG0100X
TXN5238207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1568576155Medicaid
MS00600292Medicaid
LA1541001Medicaid
TX214837101Medicaid
LA1541001Medicaid
CA1568576155Medicaid
MS00600292Medicaid