MEDICARE: ROCKY MOUNTAIN NEUROSURGERY, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	42315	CO

General Provider Information

NPI Number	:	1386915569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNTAIN NEUROSURGERY, P.C.

Provider Business Mailing Address
First Line	:	9695 S YOSEMITE ST
Second Line	:	SUITE 377
City	:	LONETREE
State	:	CO
Zip	:	80124-2888
Country	:	US
Telephone Number	:	720-484-6908
Fax Number	:	720-484-6918

Provider Business Practice Location Address
First Line	:	9695 S YOSEMITE ST
Second Line	:	SUITE 377
City	:	LONETREE
State	:	CO
Zip	:	80124-2888
Country	:	US
Telephone Number	:	720-484-6908
Fax Number	:	720-484-6918

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LLOYD WESLEY MOBLEY III
Credential	:	M.D.
Telephone Number	:	720-985-5899

Provider Enumeration Date	:	01/20/2012
Last Update Date	:	10/05/2014

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