Provider Demographics
NPI:1205810439
Name:ONEILL, ROBERT B (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:ONEILL
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 1:1150 DOVE AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-3102
Mailing Address - Country:US
Mailing Address - Phone:305-887-3531
Mailing Address - Fax:
Practice Address - Street 1:7150 W 20TH AVE
Practice Address - Street 2:STE 612
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5529
Practice Address - Country:US
Practice Address - Phone:305-827-1561
Practice Address - Fax:305-702-9662
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063187174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL214707OtherAVMED PROVIDER NUMBER
FL3918397003OtherCIGNA
FL5911195OtherAETNA PPO PROVIDER NUMBER
FL005596OtherNEIGHBORHOOD
FL205469OtherAMERIGROUP
FL2325470OtherAETNA HMO PROVIDER NUMBER
FL25718OtherBC/BS OF HEALTH OPTIONS
FL107399OtherHUMANA
FL19958OtherVISTA OF SOUTH FLORIDA
FL19958OtherVISTA OF SOUTH FLORIDA