Provider Demographics
NPI:1255399580
Name:O'NEIL, BRUCE H SR (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:H
Last Name:O'NEIL
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 INTERNATIONAL BLVD
Mailing Address - Street 2:STE 35
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-1520
Mailing Address - Country:US
Mailing Address - Phone:510-532-2500
Mailing Address - Fax:510-532-9041
Practice Address - Street 1:2700 INTERNATIONAL BLVD
Practice Address - Street 2:STE 35
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1520
Practice Address - Country:US
Practice Address - Phone:510-532-2500
Practice Address - Fax:510-532-9041
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA23100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
942302155OtherFEDERAL TAX ID #
CA00A231000Medicaid
CA00A231000Medicaid
942302155OtherFEDERAL TAX ID #