Healthcare Provider Details

I. General information

NPI: 1639370760
Provider Name (Legal Business Name): MICHAEL D O'NEAL II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 JACKSON ST HOSPITALIST
MONROE LA
71201-7407
US

IV. Provider business mailing address

309 JACKSON ST HOSPITALIST
MONROE LA
71201-7407
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-4540
  • Fax: 318-966-4543
Mailing address:
  • Phone: 318-966-4540
  • Fax: 318-966-4543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number201227
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number201227
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: