Provider Demographics
NPI:1457507337
Name:LAWRENCE E MOBLEY MD PA
Entity Type:Organization
Organization Name:LAWRENCE E MOBLEY MD PA
Other - Org Name:LAWRENCE E MOBLEY MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-484-7775
Mailing Address - Street 1:4400 BAYOU BLVD
Mailing Address - Street 2:51
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2673
Mailing Address - Country:US
Mailing Address - Phone:850-484-7775
Mailing Address - Fax:850-484-8874
Practice Address - Street 1:4400 BAYOU BLVD
Practice Address - Street 2:51
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2673
Practice Address - Country:US
Practice Address - Phone:850-484-7775
Practice Address - Fax:850-484-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME495342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1912005505OtherNPI
FLD50595Medicare UPIN
FL02653Medicare PIN