Provider Demographics
NPI:1548252612
Name:ROONEY, PATRICIA L (DO)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:ROONEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 E COMMERCIAL BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3747
Mailing Address - Country:US
Mailing Address - Phone:954-928-0088
Mailing Address - Fax:954-928-1871
Practice Address - Street 1:1880 E COMMERCIAL BLVD STE 1
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3747
Practice Address - Country:US
Practice Address - Phone:954-928-0088
Practice Address - Fax:954-928-1871
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5296208200000X
MI5101013687208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM68220OtherMEDICARE
FL80252AMedicare ID - Type Unspecified
MIOM68220OtherMEDICARE