Active NPI
Sanober Humayum Mumtaz, MD
- Family Medicine Physician
- Tyler, TX
National Provider Identifier
1316060502
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- E4553
- Practice address
- 820 E Front Street
Willow Wellness Center PA
Tyler, TX 75702 - Phone
- (903) 596-0602
- Fax
- (903) 596-0620
- NPI assigned
- Apr 10, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | E4553 | TX | Primary |
Addresses
Primary practice location
820 E Front Street
Willow Wellness Center PA
Tyler, TX 75702
Mailing address
3001 Belmead
Tyler, TX 75701
Phone (903) 530-7486
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E4553 | TX | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Radiology Associates of North Texas PA | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Diagnostic Radiology Physician
- Fort Worth, TX
- NPI 1710970975
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316060502",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3001 BELMEAD",
"city": "TYLER",
"state": "TX",
"postal_code": "75701",
"telephone_number": "903-530-7486",
"fax_number": "903-595-6547"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "820 E FRONT STREET",
"address_2": "WILLOW WELLNESS CENTER PA",
"city": "TYLER",
"state": "TX",
"postal_code": "75702",
"telephone_number": "903-596-0602",
"fax_number": "903-596-0620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUMTAZ",
"first_name": "SANOBER",
"middle_name": "HUMAYUM",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "E4553",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.