MEDICARE: SUSAN O'NEIL M.D.

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	208000000X	Pediatrics Physician	G1524	TX

General Provider Information

NPI Number	:	1659373181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN O'NEIL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 841969
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-1969
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6707 STERLING RIDGE DR
Second Line	:	A
City	:	THE WOODLANDS
State	:	TX
Zip	:	77382-2746
Country	:	US
Telephone Number	:	281-296-2656
Fax Number	:

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	07/08/2007

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