Provider Demographics
NPI:1982675641
Name:O'NEIL, JEROME H JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:H
Last Name:O'NEIL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6526 LANSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2654
Mailing Address - Country:US
Mailing Address - Phone:314-353-8777
Mailing Address - Fax:314-353-8772
Practice Address - Street 1:6526 LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2654
Practice Address - Country:US
Practice Address - Phone:314-353-8777
Practice Address - Fax:314-353-8772
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR5E53208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200057611Medicaid