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NPI Code Detail

MEDICARE: MR. ALHAJI MAHAMA MUMUNI PAC

MEDICARE: MR. ALHAJI MAHAMA MUMUNI PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA02634TX

General Provider Information

NPI Number : 1427255330
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ALHAJI MAHAMA MUMUNI PAC
Provider Business Mailing Address
First Line : 4824 VALLEY SPRINGS TRL
Second Line :
City : KELLER
State : TX
Zip : 76248-1904
Country : US
Telephone Number : 817-333-7003
Fax Number :
Provider Business Practice Location Address
First Line : 3305 MILLER AVE STE B
Second Line :
City : FORT WORTH
State : TX
Zip : 76119-1956
Country : US
Telephone Number : 817-535-2690
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2007
Last Update Date : 07/08/2007

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