Provider Demographics
NPI:1255489779
Name:O'GORMAN, RONALD B (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:B
Last Name:O'GORMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695
Mailing Address - Country:US
Mailing Address - Phone:251-410-8346
Mailing Address - Fax:251-410-8347
Practice Address - Street 1:861 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-3909
Practice Address - Country:US
Practice Address - Phone:251-410-8346
Practice Address - Fax:251-410-8347
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13943174400000X, 207P00000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No174400000XOther Service ProvidersSpecialist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0018783Medicaid
AL000019747Medicaid
AL3710050OtherUHC
AL409485OtherAETNA
FL910198500Medicaid
ALC71741OtherHEALTHSPRINGS OF AL
FL910198500Medicaid
AL3710050OtherUHC
ALC71741Medicare UPIN