Healthcare Provider Details

I. General information

NPI: 1417932740
Provider Name (Legal Business Name): EMMETT PAUL MOBLEY III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 KY HIGHWAY 36 E
CYNTHIANA KY
41031-7490
US

IV. Provider business mailing address

3732 PARK RIDGE LN
LEXINGTON KY
40509-2940
US

V. Phone/Fax

Practice location:
  • Phone: 859-229-0499
  • Fax:
Mailing address:
  • Phone: 859-543-0169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC050195
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number33721
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: