Provider Demographics
NPI:1750376885
Name:O'NEAL, JEAN PIERRE (MD)
Entity type:Individual
Prefix:
First Name:JEAN PIERRE
Middle Name:
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 1:2410 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-6004
Mailing Address - Country:US
Mailing Address - Phone:970-352-6353
Mailing Address - Fax:970-356-2264
Practice Address - Street 1:2410 W 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-6004
Practice Address - Country:US
Practice Address - Phone:970-352-6353
Practice Address - Fax:970-356-2264
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25566174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84059236901OtherPACIFICARE
CO01255660Medicaid
CO870592369005OtherROCKY MTN HEALTH
COON98498OtherBCBS
COON98498OtherBCBS
COE023631Medicare UPIN
CO84059236901OtherPACIFICARE
COCOA105943Medicare PIN