Provider Demographics
NPI:1811147002
Name:NEAL, ROBERT BENNETT JR (IDC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BENNETT
Last Name:NEAL
Suffix:JR
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7111 SEALION RD
Mailing Address - Street 2:COMMANDER, SUBMARINE DEVELOPMENT SQUADRON 5
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:98315-7111
Mailing Address - Country:US
Mailing Address - Phone:360-315-4166
Mailing Address - Fax:
Practice Address - Street 1:7111 SEALION RD
Practice Address - Street 2:COMMANDER, SUBMARINE DEVELOPMENT SQUADRON 5
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:98315-7111
Practice Address - Country:US
Practice Address - Phone:360-315-4166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman