Individual
MR. IAN ALEXANDER NEUHAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
10870 US ONE N UNIT 104, PONTE VEDRA, FL 32081-7804
(904) 438-2720
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(843) 789-1620
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2650
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2857PA
—
SC
Enumeration date
01/13/2017
Last updated
07/03/2024
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