Provider Demographics
NPI:1134557952
Name:SARUMI, MOJIRAYO A (DO)
Entity type:Individual
Prefix:
First Name:MOJIRAYO
Middle Name:A
Last Name:SARUMI
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 1:2900 SAINT MICHAEL DR STE 401
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-5211
Mailing Address - Country:US
Mailing Address - Phone:903-614-5383
Mailing Address - Fax:903-614-5343
Practice Address - Street 1:620 S FLEISHEL AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:903-606-4900
Practice Address - Fax:903-606-4699
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR9538207V00000X, 207VM0101X
PAOS017932207V00000X
NJ25MB09374900207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX825668OtherMEDICARE PIN
NJ0464660Medicaid
TX400935901Medicaid