Provider Demographics
NPI:1699807248
Name:NEELY, ALFRED WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:WILLIAM
Last Name:NEELY
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 1:22 MEADOW HAWK LN
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88022-9727
Mailing Address - Country:US
Mailing Address - Phone:575-574-7111
Mailing Address - Fax:
Practice Address - Street 1:22 MEADOW HAWK LN
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88022-9727
Practice Address - Country:US
Practice Address - Phone:575-574-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM79-71207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
A89629Medicare UPIN