Healthcare Provider Details

I. General information

NPI: 1164407151
Provider Name (Legal Business Name): MOBILE UROLOGY GROUP, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MEMORIAL HOSPITAL DR SUITE 100
MOBILE AL
36608-1786
US

IV. Provider business mailing address

101 MEMORIAL HOSPITAL DR SUITE 100
MOBILE AL
36608-1786
US

V. Phone/Fax

Practice location:
  • Phone: 251-343-9090
  • Fax: 251-380-1015
Mailing address:
  • Phone: 251-343-9090
  • Fax: 251-380-1015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT FLECK
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 251-343-9090