Provider Demographics
NPI:1467435537
Name:MOBLEY, ROBERT G (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:MOBLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:42524 HAYES RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6764
Mailing Address - Country:US
Mailing Address - Phone:586-263-1168
Mailing Address - Fax:586-263-1169
Practice Address - Street 1:42524 HAYES RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6764
Practice Address - Country:US
Practice Address - Phone:586-263-1168
Practice Address - Fax:586-263-1169
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301044262207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A76990Medicare UPIN
MIP00370001Medicare PIN