Provider Demographics
NPI:1538268131
Name:O'NEAL, HEATHER L (MD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 DODSON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-5182
Mailing Address - Country:US
Mailing Address - Phone:479-441-2600
Mailing Address - Fax:479-441-2694
Practice Address - Street 1:1500 DODSON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-5182
Practice Address - Country:US
Practice Address - Phone:479-441-2600
Practice Address - Fax:479-441-2694
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5010207Q00000X
OK30407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00619626OtherRAIL ROAD MEDICARE
OK200124390 AMedicaid
AR883158OtherHEALTHLINK
AR5N918OtherBLUE CROSS BLUE SHIELD
AR165710001Medicaid
AR165710001Medicaid