Healthcare Provider Details

I. General information

NPI: 1952382483
Provider Name (Legal Business Name): HARRY MOBLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3342 BIENVILLE RD
RINGGOLD LA
71068-3242
US

IV. Provider business mailing address

417 SOUTHAVEN LN
SHREVEPORT LA
71106-8391
US

V. Phone/Fax

Practice location:
  • Phone: 318-894-3644
  • Fax: 318-932-2186
Mailing address:
  • Phone: 318-798-3627
  • Fax: 318-932-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number011669
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: