Provider Demographics
NPI:1255353611
Name:O'NEILL, PATRICK J (DO)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:PATRICK
Other - Middle Name:J
Other - Last Name:O'NEILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:12376 COUNTY ROAD 3480
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-3325
Mailing Address - Country:US
Mailing Address - Phone:580-235-1440
Mailing Address - Fax:
Practice Address - Street 1:1150 NORTH HILLS CENTRE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-1864
Practice Address - Country:US
Practice Address - Phone:580-332-8606
Practice Address - Fax:580-332-8616
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK4149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKAAA0739Medicare PIN