Provider Demographics
NPI:1962486951
Name:NEELY, JAMES W (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:NEELY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E EVERGREEN ST
Mailing Address - Street 2:PO BOX 557
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429-2400
Mailing Address - Country:US
Mailing Address - Phone:816-632-2101
Mailing Address - Fax:816-649-3383
Practice Address - Street 1:1608 E EVERGREEN ST
Practice Address - Street 2:SUITE A
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429-2400
Practice Address - Country:US
Practice Address - Phone:816-632-3945
Practice Address - Fax:816-632-3940
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4G44207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7850046OtherMEDICARE PART B
MO242446870Medicaid
MO10050637OtherMEDICARE RAILROAD
MO242446870Medicaid