Healthcare Provider Details

I. General information

NPI: 1134557952
Provider Name (Legal Business Name): MOJIRAYO A. SARUMI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 S FLEISHEL AVE
TYLER TX
75701
US

IV. Provider business mailing address

2900 SAINT MICHAEL DR STE 401
TEXARKANA TX
75503-5211
US

V. Phone/Fax

Practice location:
  • Phone: 903-606-4900
  • Fax: 903-606-4699
Mailing address:
  • Phone: 903-614-5383
  • Fax: 903-614-5343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR9538
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOS017932
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MB09374900
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberR9538
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: