Basic Information
| Provider Information | |||||||||
| NPI: | 1598720294 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEAL | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D. O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT AT 952627 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 311922627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504768602 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8383 N DAVIS HWY | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325146039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504944000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 02/18/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | OS4526 | FL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 069307300 | 05 | FL | MEDICAID | 82557 | 01 | FL | BCBS FLORIDA | OTHER |