MEDICARE: ELIJAH MOBLEY M.D.

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	204F00000X	Transplant Surgery Physician	5725	SD
2	208600000X	Surgery Physician	CA286A	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528034212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIJAH MOBLEY M.D.

Provider Business Mailing Address
First Line	:	20258 US HIGHWAY 18
Second Line	:	PMB 514 STE 430
City	:	APPLE VALLEY
State	:	CA
Zip	:	92307-6197
Country	:	US
Telephone Number	:	760-946-0100
Fax Number	:	760-946-3176

Provider Business Practice Location Address
First Line	:	15366 11TH ST STE Q
Second Line	:
City	:	VICTORVILLE
State	:	CA
Zip	:	92395-3726
Country	:	US
Telephone Number	:	760-241-6201
Fax Number	:	760-241-6203

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	10/02/2023

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