Provider Demographics
NPI:1255418596
Name:MCNEELY, DENNIS REED (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:REED
Last Name:MCNEELY
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 1:2220 W IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-2738
Mailing Address - Country:US
Mailing Address - Phone:405-779-2721
Mailing Address - Fax:405-779-2310
Practice Address - Street 1:2220 W IOWA AVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-2738
Practice Address - Country:US
Practice Address - Phone:405-779-2721
Practice Address - Fax:405-779-2310
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15065207P00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731587852-00OtherINDIAN HEALTH SERVICES
OK5191286OtherAETNA
OK020047749OtherMEDICARE RAILROAD
OK100135670BMedicaid
OK5191286OtherAETNA
OKE31357Medicare UPIN