Healthcare Provider Details

I. General information

NPI: 1982040010
Provider Name (Legal Business Name): MOBLEY MD FACIAL PLASTIC AND RECONSTRUCTIVE SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 08/22/2013
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: 801-449-4490
  • Fax: 801-293-8101
Mailing address:
  • Phone: 801-449-4490
  • Fax: 801-293-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number5133249-1205
License Number StateUT

VIII. Authorized Official

Name: DR. STEVEN ROSS MOBLEY
Title or Position: MANAGER
Credential: M.D.
Phone: 801-449-9990