Provider Demographics
NPI:1699793158
Name:NEIL, JEFFREY JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOSEPH
Last Name:NEIL
Suffix:
Gender:
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:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-362-1408
Mailing Address - Fax:314-454-2523
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV NEUROLOGY PEDIATRICS
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-362-1408
Practice Address - Fax:314-454-2523
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180365542084N0402X
MOR7J332084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202847513Medicaid
MO916640101Medicaid
MO916640101Medicare PIN
IL$$$$$$$$$Medicaid