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General NPI Number Information
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NPI Number | 1275929929
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Entity Type | Individual
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Provider Name | JENNIFER O'NEAL MD
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Gender | Female
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 818 MONTROSE DR STE B
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City | SHREVEPORT
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State | LA
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Zip | 71106-2012
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Country | US
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Telephone | 337-302-5453
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Fax |
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Provider Business Mailing Address
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Address Line | 8702 GLEN HAVEN DR
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City | SHREVEPORT
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State | LA
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Zip | 71106-6222
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Country | US
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Telephone | 337-302-5453
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 304481
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD304481
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License Number State | LA
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