Individual
DR. JOHN MICHAEL NEIDECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
11200 GOVERNOR MANLY WAY STE 309, RALEIGH, NC 27614-7375
(919) 562-9410
(919) 562-2948
Mailing address
PO BOX 1107, WAKE FOREST, NC 27588-1107
(919) 562-9410
(919) 562-2948
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
207Q00000X
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MB08631900
MEDICAL LICENSE
NJ
Enumeration date
08/01/2007
Last updated
03/17/2018
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