MEDICARE: DR. HARRY 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	208D00000X	General Practice Physician	011669	LA

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	:	1952382483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARRY MOBLEY M.D.

Provider Business Mailing Address
First Line	:	417 SOUTHAVEN LN
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-8391
Country	:	US
Telephone Number	:	318-798-3627
Fax Number	:	318-932-2186

Provider Business Practice Location Address
First Line	:	3342 BIENVILLE RD
Second Line	:
City	:	RINGGOLD
State	:	LA
Zip	:	71068-3242
Country	:	US
Telephone Number	:	318-894-3644
Fax Number	:	318-932-2186

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	04/10/2008

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