Provider Demographics
NPI:1699750505
Name:BEENE, RONDA LAWAINE (DO)
Entity type:Individual
Prefix:DR
First Name:RONDA
Middle Name:LAWAINE
Last Name:BEENE
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 1:642 UPTOWN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-3520
Mailing Address - Country:US
Mailing Address - Phone:972-637-5100
Mailing Address - Fax:972-637-5101
Practice Address - Street 1:642 UPTOWN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-3520
Practice Address - Country:US
Practice Address - Phone:972-637-5100
Practice Address - Fax:972-637-5101
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1871207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127031601Medicaid
0090BJ1Medicare ID - Type Unspecified
TX127031601Medicaid