Provider Demographics
NPI:1356390496
Name:VEGGEBERG, NEIL (MD)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:VEGGEBERG
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 1:7219 VERSAILLES DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79121-1813
Mailing Address - Country:US
Mailing Address - Phone:806-353-7018
Mailing Address - Fax:806-353-7044
Practice Address - Street 1:5111 CANYON DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79110-3037
Practice Address - Country:US
Practice Address - Phone:806-353-7018
Practice Address - Fax:806-353-7044
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8478208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089704301Medicaid
TXB27283Medicare UPIN
TX089704301Medicaid