Individual
JASON NEALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4305 N EAGLE RD, BOISE, ID 83713-4722
(208) 939-3110
Mailing address
15320 OLD REDMOND RD, REDMOND, WA 98052-6837
(970) 581-8761
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
60961766
WA
208600000X
Surgery Physician
60961766
WA
Other
Enumeration date
06/25/2014
Last updated
10/15/2020
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