Active NPI
Ancelmo Mojarro, PTA
- Physical Medicine & Rehabilitation Physician
- Tyler, TX
National Provider Identifier
1538760640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 2154652
- Practice address
- 100 E Ferguson St
Tyler, TX 75702-5759 - Phone
- (903) 509-2040
- NPI assigned
- Nov 4, 2020
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 2154652 | TX | Primary |
Addresses
Primary practice location
100 E Ferguson St
Tyler, TX 75702-5759
Mailing address
100 E Ferguson St
Tyler, TX 75702-5759
Phone (903) 509-2040
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2154652 | TX | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604448000000",
"number": "1538760640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 E FERGUSON ST",
"city": "TYLER",
"state": "TX",
"postal_code": "757025759",
"telephone_number": "903-509-2040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 E FERGUSON ST",
"city": "TYLER",
"state": "TX",
"postal_code": "757025759",
"telephone_number": "903-509-2040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOJARRO",
"first_name": "ANCELMO",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-04",
"last_updated": "2020-11-04",
"certification_date": "2020-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "TX",
"license": "2154652",
"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 Nov 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.