Healthcare Provider Details

I. General information

NPI: 1700813102
Provider Name (Legal Business Name): KEVIN PATRICK O'NEIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 N MACARTHUR BLVD SUITE 500
IRVING TX
75062-3651
US

IV. Provider business mailing address

3501 N MACARTHUR BLVD SUITE 500
IRVING TX
75062-3651
US

V. Phone/Fax

Practice location:
  • Phone: 972-256-3700
  • Fax: 866-630-6348
Mailing address:
  • Phone: 972-256-3700
  • Fax: 866-630-6348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberK3812
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberK3812
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: