Provider Demographics
NPI:1598733917
Name:O'NEILL, EUGENE T (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:T
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 1:1738 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3236
Mailing Address - Country:US
Mailing Address - Phone:303-808-6986
Mailing Address - Fax:303-997-9443
Practice Address - Street 1:1738 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3236
Practice Address - Country:US
Practice Address - Phone:303-808-6986
Practice Address - Fax:303-997-9443
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01183953Medicaid
COD23430Medicare UPIN
CO01183953Medicaid