Provider Demographics
NPI:1972528974
Name:NEAL, MICHAEL D (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:NEAL
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:PO BOX 442
Mailing Address - Street 2:7502 COUNTY ROAD 410
Mailing Address - City:MERTZON
Mailing Address - State:TX
Mailing Address - Zip Code:76941
Mailing Address - Country:US
Mailing Address - Phone:325-835-7062
Mailing Address - Fax:325-835-2414
Practice Address - Street 1:7502 COUNTY ROAD 410
Practice Address - Street 2:
Practice Address - City:MERTZON
Practice Address - State:TX
Practice Address - Zip Code:76941
Practice Address - Country:US
Practice Address - Phone:325-835-7062
Practice Address - Fax:325-835-2414
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0674207P00000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00B85QOtherMEDICARE PART B
TX092496102Medicaid
TX138760721Medicaid
TX092496102Medicaid
TXC19805Medicare UPIN
TX138760721Medicaid