Healthcare Provider Details

I. General information

NPI: 1265522874
Provider Name (Legal Business Name): STEVEN ROSS MOBLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5292 S COLLEGE DR SUITE 303
MURRAY UT
84123-2958
US

IV. Provider business mailing address

5292 S COLLEGE DR SUITE 303
MURRAY UT
84123-2958
US

V. Phone/Fax

Practice location:
  • Phone: 801-449-9990
  • Fax:
Mailing address:
  • Phone: 801-449-9990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number5133249-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: