Provider Demographics
NPI:1215983788
Name:THOMAS F. NEAL, M.D., STAN E. POTOCKI, M.D., PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:THOMAS F. NEAL, M.D., STAN E. POTOCKI, M.D., PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:POTOCKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-792-5331
Mailing Address - Street 1:3621 22ND ST
Mailing Address - Street 2:STE 300
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1301
Mailing Address - Country:US
Mailing Address - Phone:806-792-5331
Mailing Address - Fax:806-792-9417
Practice Address - Street 1:3621 22ND ST
Practice Address - Street 2:STE 300
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1301
Practice Address - Country:US
Practice Address - Phone:806-792-5331
Practice Address - Fax:806-792-9417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0092DQOtherBC/BS
TX00W839Medicare PIN