Provider Demographics
NPI:1649657842
Name:MOONEY, RYAN PATRICK (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:PATRICK
Last Name:MOONEY
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 1:5300 W PLANO PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4861
Mailing Address - Country:US
Mailing Address - Phone:972-612-8037
Mailing Address - Fax:972-543-1984
Practice Address - Street 1:5300 W PLANO PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4861
Practice Address - Country:US
Practice Address - Phone:972-612-8037
Practice Address - Fax:972-543-1984
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS4531208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program