Provider Demographics
NPI:1548264203
Name:HENRY J O'NEAL, M.D.,P.A.
Entity type:Organization
Organization Name:HENRY J O'NEAL, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-971-8088
Mailing Address - Street 1:13701 BRUCE B DOWNS BLVD
Mailing Address - Street 2:STE 113
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4647
Mailing Address - Country:US
Mailing Address - Phone:813-971-8088
Mailing Address - Fax:813-971-3871
Practice Address - Street 1:13701 BRUCE B DOWNS BLVD
Practice Address - Street 2:STE 113
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4647
Practice Address - Country:US
Practice Address - Phone:813-971-8088
Practice Address - Fax:813-971-3871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46531207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG87167Medicare UPIN