Provider Demographics
NPI:1770518516
Name:OOMMEN, JOSEPH ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:OOMMEN
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 1:3560 DELAWARE ST
Mailing Address - Street 2:STE 1104
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3000
Mailing Address - Country:US
Mailing Address - Phone:409-347-8870
Mailing Address - Fax:409-347-8878
Practice Address - Street 1:3560 DELAWARE ST STE 1104
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3000
Practice Address - Country:US
Practice Address - Phone:409-347-8870
Practice Address - Fax:409-347-8878
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM74912084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX760010407OtherTIN
TX760010407OtherTIN
TX00R518Medicare PIN
CAI41763Medicare UPIN
TX8G8868Medicare PIN
TXCI5830Medicare PIN