Provider Demographics
NPI:1588007926
Name:O'NEILL, DANIEL F (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:F
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 1:6420 SW MACADAM AVE
Mailing Address - Street 2:STE. 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3507
Mailing Address - Country:US
Mailing Address - Phone:503-941-3033
Mailing Address - Fax:
Practice Address - Street 1:10690 NE CORNELL RD STE 220
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9224
Practice Address - Country:US
Practice Address - Phone:503-848-5861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORML60371653208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500712901Medicaid