Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 25MB09374900 | NJ |
N | 207V00000X | Obstetrician & Gynecologist | OS017932 | PA |
N | 207V00000X | Obstetrician & Gynecologist | R9538 | TX |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | R9538 | TX |
NPI | 1134557952 |
---|---|
Provider Name | Mojirayo A. Sarumi |
First Address | Texarkana, TX 75503-5211 |
Second Address | Tyler, TX 75701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2013 |
Last Update Date | 02/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0464660 | (05) | NJ |
400935901 | (05) | TX |
825668 | MEDICARE PIN (01) | TX |