Individual
BRYAN T O'NEALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4515 MARSHA SHARP FWY, LUBBOCK, TX 79407-2520
(806) 744-7223
(806) 740-3325
Mailing address
4515 MARSHA SHARP FWY, LUBBOCK, TX 79407-2520
(806) 744-7223
(806) 740-3325
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TX PA 02717
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
161309100
FIRSTCARE - GRACE CLINIC
TX
05
—
1975187-01
—
TX
01
—
5892790001
MEDICARE NSC - GRACE CLINIC
TX
01
—
7271774
AETNA - GRACE CLINIC
TX
01
—
8AM633
BCBS - GRACE CLINIC
TX
01
—
8L3991
MEDICARE PIN - GRACE CLINIC
TX
Enumeration date
11/22/2005
Last updated
07/09/2019
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