Provider Demographics
NPI:1093897092
Name:O'NEILL, DANIEL P (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 59028
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-2028
Mailing Address - Country:US
Mailing Address - Phone:425-251-5110
Mailing Address - Fax:425-793-4707
Practice Address - Street 1:4011 TALBOT RD S
Practice Address - Street 2:SUITE 500
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5773
Practice Address - Country:US
Practice Address - Phone:425-251-5110
Practice Address - Fax:425-793-7380
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013433207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA110051023OtherRR MEDICARE
WAON1353OtherREGENCE
WA1652106Medicaid
WA0057616OtherL&I
WAON1353OtherREGENCE
WA000103949Medicare PIN