Provider Demographics
NPI:1972573533
Name:ROONEY, JOHN T (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:ROONEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1200 N BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3118
Mailing Address - Country:US
Mailing Address - Phone:928-213-6235
Mailing Address - Fax:928-213-6292
Practice Address - Street 1:61 BELL ROCK PLZ
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-8810
Practice Address - Country:US
Practice Address - Phone:928-204-4999
Practice Address - Fax:928-204-4990
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-7361-R207Q00000X
AZ005967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2327815Medicaid
AZ724058Medicaid
OH4071833Medicare PIN
AZ724058Medicaid
AZZ91995Medicare PIN