Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 45969 | KY |
Y | 207QA0505X | Family Doctor - Adult Medicine | 45969 | KY |
NPI | 1316135833 |
---|---|
Provider Name | Dr. Ernest Thompson O'neal |
First Address | Klamath Falls, OR 97603 |
Second Address | Klamath Falls, OR 97603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2007 |
Last Update Date | 30/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100235470 | (05) | KY |