Provider Demographics
NPI:1194742833
Name:MCNEELY, JEFFERY CLAYTON (DPM)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:CLAYTON
Last Name:MCNEELY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 50TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79412-2619
Mailing Address - Country:US
Mailing Address - Phone:806-744-1168
Mailing Address - Fax:806-744-2368
Practice Address - Street 1:2126 50TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-2619
Practice Address - Country:US
Practice Address - Phone:806-744-1168
Practice Address - Fax:806-744-2368
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX1287213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85Y200OtherBCBS
TX089901502Medicaid
TX089901502Medicaid
TX85Y200OtherBCBS
TXU55658Medicare UPIN