Individual
ANCELMO MOJARRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
100 E FERGUSON ST, TYLER, TX 75702-5759
(903) 509-2040
Mailing address
100 E FERGUSON ST, TYLER, TX 75702-5759
(903) 509-2040
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2154652
TX
Other
Enumeration date
11/04/2020
Last updated
11/04/2020
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