Individual
EDWARD KIRK NEELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
751 S BASCOM AVE, SAN JOSE, CA 95128-2604
(408) 885-7422
Mailing address
576 CRESTA VISTA LN, PORTOLA VALLEY, CA 94028-7729
(650) 723-5791
Taxonomy
Speciality
Code
Description
License number
State
2080P0205X
Pediatric Endocrinology Physician
Primary
G55037
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G550370
—
CA
Enumeration date
12/12/2005
Last updated
05/15/2012
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