Provider Demographics
NPI:1821082033
Name:NEAL, JOHN BENNETT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BENNETT
Last Name:NEAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3917 WEST RD
Mailing Address - Street 2:#128
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2275
Mailing Address - Country:US
Mailing Address - Phone:505-662-3073
Mailing Address - Fax:505-662-7894
Practice Address - Street 1:3917 WEST RD
Practice Address - Street 2:#128
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2275
Practice Address - Country:US
Practice Address - Phone:505-662-3073
Practice Address - Fax:505-662-7894
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM87124208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM51342Medicaid