Provider Demographics
NPI:1568807196
Name:LOONEY, ROBERT RYAN (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:RYAN
Last Name:LOONEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1326
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39760-1326
Mailing Address - Country:US
Mailing Address - Phone:662-615-3771
Mailing Address - Fax:662-615-3775
Practice Address - Street 1:107 BRANDON RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2521
Practice Address - Country:US
Practice Address - Phone:662-615-3770
Practice Address - Fax:662-615-3775
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24310207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08539354Medicaid