1427477736 NPI number — DR. BARRON JOHNS O'NEAL JR. MD

Table of content: DR. BARRON JOHNS O'NEAL JR. MD (NPI 1427477736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427477736 NPI number — DR. BARRON JOHNS O'NEAL JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'NEAL
Provider First Name:
BARRON
Provider Middle Name:
JOHNS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427477736
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3488, DEPT 05-039
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUPELO
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38803-3488
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-300-3643
Provider Business Mailing Address Fax Number:
888-511-4191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 KINGS HWY
Provider Second Line Business Practice Location Address:
SURGERY
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71103-4228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-813-2655
Provider Business Practice Location Address Fax Number:
318-813-2673
Provider Enumeration Date:
04/15/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  312274 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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