Provider Demographics
NPI:1962463869
Name:MONGARE, JOB (MD)
Entity type:Individual
Prefix:
First Name:JOB
Middle Name:
Last Name:MONGARE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 N MURCHISON ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-2109
Mailing Address - Country:US
Mailing Address - Phone:903-677-6006
Mailing Address - Fax:903-677-9006
Practice Address - Street 1:113 N MURCHISON ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-2109
Practice Address - Country:US
Practice Address - Phone:903-677-6006
Practice Address - Fax:903-677-9006
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8954174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH06040Medicare UPIN