Provider Demographics
NPI:1770861288
Name:O'NEAL MEDICAL SERVICES A PROFESSIONAL LLC
Entity Type:Organization
Organization Name:O'NEAL MEDICAL SERVICES A PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:318-396-2715
Mailing Address - Street 1:125 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7356
Mailing Address - Country:US
Mailing Address - Phone:318-396-2715
Mailing Address - Fax:
Practice Address - Street 1:125 SUNSET DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7356
Practice Address - Country:US
Practice Address - Phone:318-396-2715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201227207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty