Provider Demographics
NPI:1124253893
Name:NEALE, JEFFREY ALLAN (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALLAN
Last Name:NEALE
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: MANAGED CARE DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:13770 PLANTATION RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4301
Practice Address - Country:US
Practice Address - Phone:239-275-0728
Practice Address - Fax:239-275-6947
Is Sole Proprietor?:No
Enumeration Date:2009-05-24
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT185247208600000X
FLME107209208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002981900Medicaid
FL1231758OtherWELLCARE
FL14A66OtherBCBS FL
FLP00956373OtherRAILROAD MCR
FL287851OtherUNIVERSAL
FL1231758OtherWELLCARE