Provider Demographics
NPI:1063513240
Name:MOJICA, JOHN JR (PA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MOJICA
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650859 DEPT 710
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-3537
Mailing Address - Country:US
Mailing Address - Phone:409-772-0620
Mailing Address - Fax:281-282-0760
Practice Address - Street 1:2240 GULF FWY S
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-5143
Practice Address - Country:US
Practice Address - Phone:832-505-1234
Practice Address - Fax:281-282-0760
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02786363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1063513240OtherTRICARE SOUTH
TX1063513240OtherBCBSTX
84P512Medicare ID - Type Unspecified
TX8L25809Medicare PIN
TX1063513240OtherBCBSTX