| Jacqueline Moraa Mogusu, | |
|
4541 N Josey Ln Ste 110, Carrollton, TX 75010-4622 | |
| (469) 788-8588 | |
| (469) 788-7800 |
| Full Name | Jacqueline Moraa Mogusu |
|---|---|
| Gender | Female |
| Speciality | General Practice |
| Location | 4541 N Josey Ln Ste 110, Carrollton, Texas |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881162527 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | AP138452 (Texas) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | AP138452 (Texas) | Secondary |
| 208D00000X | General Practice | AP138452 (Texas) | Primary |
| Entity Name | Burn And Reconstructive Centers Of Texas |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1316325905 PECOS PAC ID: 4981913092 Enrollment ID: O20151012000799 |
| Entity Name | Little Lantern Clinic Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1114409133 PECOS PAC ID: 0446502322 Enrollment ID: O20181003001751 |
| Entity Name | Mendivil Clinic For Foot & Ankle |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1396524054 PECOS PAC ID: 3274988860 Enrollment ID: O20231017003840 |
| Mailing Address | Practice Location Address |
|---|---|
| Jacqueline Moraa Mogusu, Po Box 12187, Augusta, GA 30914-2187 Ph: (706) 863-9595 | Jacqueline Moraa Mogusu, 4541 N Josey Ln Ste 110, Carrollton, TX 75010-4622 Ph: (469) 788-8588 |
David R Parker Jr., MD General Practice Medicare: Accepting Medicare Assignments Practice Location: 4541 N Josey Ln Ste 110, Carrollton, TX 75010 Phone: 469-788-8588 Fax: 469-788-7800 | |
Dr. Ronald Lewis Proctor, DDS General Practice Medicare: Medicare Enrolled Practice Location: 3740 N Josey Ln, Ste 121, Carrollton, TX 75007 Phone: 972-492-2866 Fax: 972-394-0583 |