Provider Demographics
NPI:1649297078
Name:NEALL, KERRY LENNARD (MD)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:LENNARD
Last Name:NEALL
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 1:1900 DON WICKHAM DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1979
Mailing Address - Country:US
Mailing Address - Phone:352-241-7180
Mailing Address - Fax:352-241-7184
Practice Address - Street 1:1900 DON WICKHAM DR
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1979
Practice Address - Country:US
Practice Address - Phone:352-241-7180
Practice Address - Fax:352-241-7184
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053969207PE0004X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378600300Medicaid
FL062306700Medicaid
FL1803209Medicaid
FL062306700Medicaid
FL09839TMedicare ID - Type Unspecified