Healthcare Provider Details

I. General information

NPI: 1760504823
Provider Name (Legal Business Name): RONALD CLIFFORD MOOMAW D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6839 COMMUNICATIONS PKWY
PLANO TX
75024-5991
US

IV. Provider business mailing address

15 LAKEWOOD LN
SEABROOK TX
77586-3432
US

V. Phone/Fax

Practice location:
  • Phone: 972-733-7242
  • Fax:
Mailing address:
  • Phone: 614-205-0985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number34-03169
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberN6503
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: