Provider Demographics
NPI:1376595942
Name:MOONEY, JOSEPH F JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:MOONEY
Suffix:JR
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 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1343 N FOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1422
Practice Address - Country:US
Practice Address - Phone:937-390-5000
Practice Address - Fax:937-390-5526
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062128M207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000302736OtherANTHEM
OH000000317071OtherANTHEM/BCBS
OH000000316075OtherBCBS FAIRFIELD
OH0864382Medicaid
OH000000302735OtherANTHEM
OH000000302735OtherBCBS
OH0925075Medicaid
OHP00034013Medicare PIN
OHP00105181Medicare PIN
OH0864382Medicaid
OHMO4280251Medicare PIN
F08539Medicare UPIN
OH0925075Medicaid
OHP00185023Medicare PIN
OH000000302736OtherANTHEM
OHP00063613Medicare PIN
OH000000302735OtherANTHEM
OH741696Medicare PIN