Provider Demographics
NPI:1134234750
Name:O'NEAL, MICHAEL R (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:O'NEAL
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 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-794-8065
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:102 SHELBY SPEIGHTS DR
Practice Address - Street 2:
Practice Address - City:PURVIS
Practice Address - State:MS
Practice Address - Zip Code:39475-4151
Practice Address - Country:US
Practice Address - Phone:601-794-8065
Practice Address - Fax:601-794-5650
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00010767Medicaid
MS080021153OtherRAILROAD MEDICARE
MS2292726OtherAMERICAN ADMIN GROUP
LA1502308Medicaid
MS080001029Medicare PIN
MS00010767Medicaid