Provider Demographics
NPI:1831155381
Name:O'NEILL, JOHN GREY III (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GREY
Last Name:O'NEILL
Suffix:III
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 1:12404 HATTON CHASE LN W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-4435
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12404 HATTON CHASE LN W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258
Practice Address - Country:US
Practice Address - Phone:904-386-3359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME878332085N0700X, 2085R0202X
CAC552782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB281166OtherMEDICARE CA
FL267254500Medicaid
CACA282270OtherMEDICARE CA
CAP01893755OtherRAILROAD MEDICARE
CACA266418OtherMEDICARE CA
CAP01965489OtherRAILROAD MEDICARE
CA7726991OtherCIGNA
CACA266394OtherMEDICARE CA