Provider Demographics
NPI:1790745685
Name:DENNIS, RONNIE WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:WAYNE
Last Name:DENNIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 JENNY GEORGE LN
Mailing Address - Street 2:STE 5
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-7152
Mailing Address - Country:US
Mailing Address - Phone:325-235-1888
Mailing Address - Fax:325-235-1889
Practice Address - Street 1:301 JENNY GEORGE LN
Practice Address - Street 2:STE 5
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-7152
Practice Address - Country:US
Practice Address - Phone:325-235-1888
Practice Address - Fax:325-235-1889
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7533207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC138103Medicaid
SCC-604510281SMedicare ID - Type Unspecified
SCC-60451Medicare UPIN