Provider Demographics
NPI:1104855972
Name:BEIGHTOL, NEAL (MD)
Entity type:Individual
Prefix:
First Name:NEAL
Middle Name:
Last Name:BEIGHTOL
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:PO BOX 7279
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34101-7279
Mailing Address - Country:US
Mailing Address - Phone:239-649-5020
Mailing Address - Fax:239-307-5169
Practice Address - Street 1:1845 SAN MARCO RD STE 303
Practice Address - Street 2:
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-6712
Practice Address - Country:US
Practice Address - Phone:239-649-5020
Practice Address - Fax:239-307-5193
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41930XMedicare PIN
P00277821Medicare PIN
H06884Medicare UPIN