Provider Demographics
NPI:1851453922
Name:GARY W. NEAL MD, PLLC
Entity Type:Organization
Organization Name:GARY W. NEAL MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-968-4444
Mailing Address - Street 1:260 MIDWAY MEDICAL PARK
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1721
Mailing Address - Country:US
Mailing Address - Phone:423-968-4444
Mailing Address - Fax:423-844-0359
Practice Address - Street 1:260 MIDWAY MEDICAL PARK
Practice Address - Street 2:SUITE 2G
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1721
Practice Address - Country:US
Practice Address - Phone:423-968-4444
Practice Address - Fax:423-844-0359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4284719OtherBLUE CROSS BLUE SHIELD TN
TN4284719OtherBLUE CROSS BLUE SHIELD TN