Provider Demographics
NPI:1861496580
Name:RONAGHAN, JOSEPH EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:EDWARD
Last Name:RONAGHAN
Suffix:
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 1:2737 S HULEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-9535
Mailing Address - Country:US
Mailing Address - Phone:682-777-4008
Mailing Address - Fax:817-927-7568
Practice Address - Street 1:2737 S HULEN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-9535
Practice Address - Country:US
Practice Address - Phone:682-777-4008
Practice Address - Fax:817-927-7568
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0651208600000X, 2086X0206X
TXJ-0651208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CN565OtherBCBS
TX136218804Medicaid
TX136218811Medicaid
TXP00198804OtherRR MEDICARE
TXP01031528OtherRAILROAD MEDICARE
TX8CN565OtherBCBS
TX136218811Medicaid
TXTXB114874Medicare PIN