Provider Demographics
NPI:1699739052
Name:HADDOCK, NEIL F (MD)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:F
Last Name:HADDOCK
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 1:325 E SONTERRA BLVD
Mailing Address - Street 2:SUITE # 110
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4054
Mailing Address - Country:US
Mailing Address - Phone:210-496-5792
Mailing Address - Fax:210-496-7601
Practice Address - Street 1:325 E SONTERRA BLVD
Practice Address - Street 2:SUITE # 110
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4054
Practice Address - Country:US
Practice Address - Phone:210-496-5792
Practice Address - Fax:210-496-7601
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9519174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00B33LMedicare ID - Type Unspecified
TXB23236Medicare UPIN