Provider Demographics
NPI:1598830200
Name:MCNEIL, LEONARD SIMS (PA)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:SIMS
Last Name:MCNEIL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:40 BURTON HILLS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6155
Mailing Address - Country:US
Mailing Address - Phone:615-565-1733
Mailing Address - Fax:615-296-0151
Practice Address - Street 1:901 SW GOODYEAR BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9755
Practice Address - Country:US
Practice Address - Phone:580-510-6361
Practice Address - Fax:580-531-5779
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK1133363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK247601201Medicare ID - Type UnspecifiedPROVIDER MEDICARE NUMBER
OKP55630Medicare UPIN