Provider Demographics
NPI:1467617589
Name:BOJANG, MOHAMED OMAR (NP)
Entity Type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:OMAR
Last Name:BOJANG
Suffix:
Gender:M
Credentials:NP
Other - Prefix:MR
Other - First Name:MOMODOU
Other - Middle Name:OMAR
Other - Last Name:BOJANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9529 OXBOW LN
Mailing Address - Street 2:
Mailing Address - City:OAK POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75068-1299
Mailing Address - Country:US
Mailing Address - Phone:615-202-6395
Mailing Address - Fax:
Practice Address - Street 1:5959 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-1400
Practice Address - Country:US
Practice Address - Phone:214-645-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127828363LF0000X
WI162624-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35064300Medicaid