Provider Demographics
NPI:1740327840
Name:NEAL, WILLIAM C (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:NEAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7369
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-7369
Mailing Address - Country:US
Mailing Address - Phone:307-734-5999
Mailing Address - Fax:307-734-0345
Practice Address - Street 1:945 WEST BRAODWAY
Practice Address - Street 2:SUITE 202
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-7369
Practice Address - Country:US
Practice Address - Phone:307-734-5999
Practice Address - Fax:307-734-0345
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY6102A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY113621600Medicaid
WYP00165173OtherRAILROAD MEDICARE
WY5424620001Medicare NSC
ID1129636Medicare PIN
WY113621600Medicaid
WYA49542Medicare UPIN