Provider Demographics
NPI:1851500359
Name:OOMMEN, STACY THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:THOMAS
Last Name:OOMMEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:515 W MAYFIELD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-4596
Mailing Address - Country:US
Mailing Address - Phone:817-468-4689
Mailing Address - Fax:817-465-7872
Practice Address - Street 1:515 W MAYFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-4596
Practice Address - Country:US
Practice Address - Phone:817-468-4689
Practice Address - Fax:817-465-7872
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-126582207V00000X
TXR9874207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology