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General NPI Number Information
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NPI Number | 1285115931
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Entity Type | Organization
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Legal Business Name | MOBILE MEDICAL PROS PLLC
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 3857 COOPER ST
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City | JACKSON
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State | MI
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Zip | 49201-7547
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Country | US
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Telephone | 303-656-9758
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Fax |
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Provider Business Mailing Address
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Address Line | 10503 MAUMELLE BLVD STE 4B
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City | N LITTLE ROCK
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State | AR
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Zip | 72113-6742
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Country | US
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Telephone | 303-656-9758
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | PATRICK ROBERTS
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Credential |
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Telephone | 303-656-9758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301116339
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License Number State | MI
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