MEDICARE: JOSEPH W O'NEAL JR. PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	2417	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255704623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH W O'NEAL JR. PA

Provider Business Mailing Address
First Line	:	PO BOX 13955
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29422-3955
Country	:	US
Telephone Number	:	843-412-1590
Fax Number	:	843-225-3549

Provider Business Practice Location Address
First Line	:	200 MIDDLEBURG DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-3408
Country	:	US
Telephone Number	:	843-903-6650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2015
Last Update Date	:	02/06/2020

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