Healthcare Provider Details

I. General information

NPI: 1134577877
Provider Name (Legal Business Name): KEYAN MOBLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BLOSSOM ST FL 4
WEBSTER TX
77598-4204
US

IV. Provider business mailing address

PO BOX 650859 DEPT. 710
DALLAS TX
75265-0859
US

V. Phone/Fax

Practice location:
  • Phone: 832-505-4000
  • Fax: 832-632-7866
Mailing address:
  • Phone: 409-772-0531
  • Fax: 409-772-0557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberBP10056566
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberT7656
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: