Healthcare Provider Details

I. General information

NPI: 1346391562
Provider Name (Legal Business Name): DAVID LYNN MOBLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 S TAMIAMI TRL
SARASOTA FL
34239-3806
US

IV. Provider business mailing address

2255 S TAMIAMI TRL
SARASOTA FL
34239-3806
US

V. Phone/Fax

Practice location:
  • Phone: 941-366-8897
  • Fax: 941-366-0518
Mailing address:
  • Phone: 941-366-8897
  • Fax: 941-366-0518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME0066996
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: