Provider Demographics
NPI:1467634386
Name:MOBILE DOCTORS, LLC
Entity Type:Organization
Organization Name:MOBILE DOCTORS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:OLADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-218-8542
Mailing Address - Street 1:1121 N 44TH ST
Mailing Address - Street 2:STE 1043
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-5706
Mailing Address - Country:US
Mailing Address - Phone:602-218-8542
Mailing Address - Fax:602-670-5965
Practice Address - Street 1:1121 N 44TH ST
Practice Address - Street 2:STE 1043
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-5706
Practice Address - Country:US
Practice Address - Phone:602-218-8542
Practice Address - Fax:602-670-5965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32339207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBO8230877OtherDEA
AZBO8230877OtherDEA