Basic Information
| Provider Information | |||||||||
| NPI: | 1669444337 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEELAND | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | BLAIR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2055 NORMANDIE DR | ||||||||
| Address2: | 108 | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361112732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342884624 | ||||||||
| FaxNumber: | 3342803628 | ||||||||
| Practice Location | |||||||||
| Address1: | 2055 NORMANDIE DR | ||||||||
| Address2: | 108 | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361112732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342884624 | ||||||||
| FaxNumber: | 3342803628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 11/02/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 00007989 | AL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | ME90164 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 0000-20942 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 000058866 | 01 | AL | IDTF | OTHER | 009968475 | 05 | AL | MEDICAID | 009945290 | 05 | AL | MEDICAID | 009968495 | 05 | AL | MEDICAID | 107019 | 05 | AL | MEDICAID | 000045292 | 05 | AL | MEDICAID | 107018 | 05 | AL | MEDICAID | 000045290 | 05 | AL | MEDICAID | 051504364 | 01 | AL | IDTF | OTHER | 009968485 | 05 | AL | MEDICAID | 108194 | 05 | AL | MEDICAID | 000058867 | 01 | AL | IDTF | OTHER | 000085896 | 05 | AL | MEDICAID | 270024700 | 05 | FL | MEDICAID | 000083515 | 05 | AL | MEDICAID | 009965385 | 05 | AL | MEDICAID | 009974205 | 05 | AL | MEDICAID | 108460 | 05 | AL | MEDICAID |