Provider Demographics
NPI:1760504823
Name:MOOMAW, RONALD CLIFFORD (DO)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:CLIFFORD
Last Name:MOOMAW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15 LAKEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-3432
Mailing Address - Country:US
Mailing Address - Phone:614-205-0985
Mailing Address - Fax:
Practice Address - Street 1:6839 COMMUNICATIONS PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5991
Practice Address - Country:US
Practice Address - Phone:972-733-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-031692084P0800X
TXN65032083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34003169OtherLICENSE NUMBER OHIO
OH06253415Medicaid
TXN6503OtherTEXAS LICENSE
TXV0174052OtherDPS TEXAS
TXV0174052OtherDPS TEXAS
TXV0174052OtherDPS TEXAS
TXN6503OtherTEXAS LICENSE