Provider Demographics
NPI:1780979435
Name:SKARIA, RONY THOMAS (MD)
Entity type:Individual
Prefix:
First Name:RONY
Middle Name:THOMAS
Last Name:SKARIA
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 1:2215 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-4800
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:4015 22ND PL
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1119
Practice Address - Country:US
Practice Address - Phone:806-725-0030
Practice Address - Fax:806-725-0015
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ01772080S0010X, 208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX342451702Medicaid
TX8FM158OtherBCBS TX
TX389212YKT8OtherMEDICARE
TX393061100OtherFIRSTCARE
NM36958565Medicaid