MEDICARE: DR. BEN HUR PATRICIO MOBO JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD452132	PA

General Provider Information

NPI Number	:	1477651453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEN HUR PATRICIO MOBO JR. MD

Provider Business Mailing Address
First Line	:	2450 W HUNTING PARK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1302
Country	:	US
Telephone Number	:	215-204-2679
Fax Number	:	215-204-1784

Provider Business Practice Location Address
First Line	:	1700 N BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19121-3429
Country	:	US
Telephone Number	:	215-204-2679
Fax Number	:	215-204-1784

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	03/13/2018

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