Provider Demographics
NPI:1255364485
Name:NEECE, C DAVID (DO)
Entity type:Individual
Prefix:DR
First Name:C DAVID
Middle Name:
Last Name:NEECE
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 1:100 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WALSENBURG
Mailing Address - State:CO
Mailing Address - Zip Code:81089-1910
Mailing Address - Country:US
Mailing Address - Phone:719-738-1164
Mailing Address - Fax:719-738-3399
Practice Address - Street 1:100 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WALSENBURG
Practice Address - State:CO
Practice Address - Zip Code:81089-1910
Practice Address - Country:US
Practice Address - Phone:719-738-1164
Practice Address - Fax:719-738-3399
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27053208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01270537Medicaid
COC444688Medicare ID - Type Unspecified
CO01270537Medicaid