Healthcare Provider Details

I. General information

NPI: 1841899887
Provider Name (Legal Business Name): MARGIE FAYE HOBERG NMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15278 W BELL RD STE 103
SURPRISE AZ
85374-3100
US

IV. Provider business mailing address

8706 N 58TH LN
GLENDALE AZ
85302-4641
US

V. Phone/Fax

Practice location:
  • Phone: 602-432-4055
  • Fax:
Mailing address:
  • Phone: 479-409-7096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number20-19110
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number20-10110
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number20-19110
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: