Individual
JOHN LEE MCNEILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3002 SAM HOUSTON DR, VICTORIA, TX 77904-2682
(361) 578-5730
(361) 578-0749
Mailing address
3002 SAM HOUSTON DR, VICTORIA, TX 77904-2682
(361) 578-5730
(361) 578-0749
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
K5623
TX
207R00000X
Internal Medicine Physician
K5623
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0034ET
BCBS OF TX #
TX
05
—
139635007
—
TX
01
—
74-2964639
TAX ID #
TX
01
—
DH0924
MEDICARE RR
TX
Enumeration date
12/16/2005
Last updated
08/14/2017
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