Healthcare Provider Details

I. General information

NPI: 1790893071
Provider Name (Legal Business Name): TERRENCE JAY O'NEIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JAMES QUILLEN VA MEDICAL CENTER SIDNEY & LAMONT ST'S- BOX 4000 - MAIL STOP CODE 11A
MOUNTAIN HOME TN
37684-4000
US

IV. Provider business mailing address

P.O. BOX 4000 MAIL STOP 11A; ACOS/AMBCARE
MOUNTAIN HOME TN
37684
US

V. Phone/Fax

Practice location:
  • Phone: 423-926-1171
  • Fax: 423-979-3522
Mailing address:
  • Phone: 423-926-1171
  • Fax: 423-979-3522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: