Provider Demographics
NPI:1952336059
Name:NEDLEY, NEIL A (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:A
Last Name:NEDLEY
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 1:13300 NEW AIRPORT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-7407
Mailing Address - Country:US
Mailing Address - Phone:530-823-5300
Mailing Address - Fax:530-823-5301
Practice Address - Street 1:13300 NEW AIRPORT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-7407
Practice Address - Country:US
Practice Address - Phone:530-823-5300
Practice Address - Fax:530-823-5301
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16858207R00000X, 207RC0000X, 207RG0100X
CAG88388207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100710290AMedicaid
OK100710290AMedicaid
E11737Medicare UPIN