Provider Demographics
NPI:1427255330
Name:MUMUNI, ALHAJI MAHAMA (PAC)
Entity type:Individual
Prefix:MR
First Name:ALHAJI
Middle Name:MAHAMA
Last Name:MUMUNI
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4824 VALLEY SPRINGS TRL
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-1904
Mailing Address - Country:US
Mailing Address - Phone:817-333-7003
Mailing Address - Fax:
Practice Address - Street 1:3305 MILLER AVE STE B
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-1956
Practice Address - Country:US
Practice Address - Phone:817-535-2690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02634363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical