Provider Demographics
NPI:1295104461
Name:ONEAL, JEREMY DORANCE (MSCI, RDN, LD)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:DORANCE
Last Name:ONEAL
Suffix:
Gender:M
Credentials:MSCI, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 SE 36TH PL
Mailing Address - Street 2:UNIT 22
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1858
Mailing Address - Country:US
Mailing Address - Phone:812-350-9833
Mailing Address - Fax:
Practice Address - Street 1:3737 SE 36TH PL
Practice Address - Street 2:UNIT 22
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1858
Practice Address - Country:US
Practice Address - Phone:812-350-9833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2023-07-26
Deactivation Date:2023-07-08
Deactivation Code:
Reactivation Date:2023-07-26
Provider Licenses
StateLicense IDTaxonomies
OR10172220133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10172220OtherOREGON LICENSE