Provider Demographics
NPI:1164407151
Name:MOBILE UROLOGY GROUP, P.A.
Entity Type:Organization
Organization Name:MOBILE UROLOGY GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FLECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-343-9090
Mailing Address - Street 1:101 MEMORIAL HOSPITAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1786
Mailing Address - Country:US
Mailing Address - Phone:251-343-9090
Mailing Address - Fax:251-380-1015
Practice Address - Street 1:101 MEMORIAL HOSPITAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1786
Practice Address - Country:US
Practice Address - Phone:251-343-9090
Practice Address - Fax:251-380-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0635230001OtherDMERC JURISDICTION C
AL0635230001OtherDMERC JURISDICTION C