Provider Demographics
NPI:1295175651
Name:EVERSON, NEAL (DO)
Entity type:Individual
Prefix:
First Name:NEAL
Middle Name:
Last Name:EVERSON
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 1:3745 GEIST RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3554
Mailing Address - Country:US
Mailing Address - Phone:907-456-3338
Mailing Address - Fax:
Practice Address - Street 1:2310 PEGER RD STE 105
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5305
Practice Address - Country:US
Practice Address - Phone:907-479-2663
Practice Address - Fax:907-479-2691
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020630207X00000X
AK139353207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty