Provider Demographics
NPI:1477651453
Name:MOBO, BEN HUR PATRICIO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:BEN HUR
Middle Name:PATRICIO
Last Name:MOBO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-204-2679
Mailing Address - Fax:215-204-1784
Practice Address - Street 1:1700 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-3429
Practice Address - Country:US
Practice Address - Phone:215-204-2679
Practice Address - Fax:215-204-1784
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD452132207Q00000X
CT038868207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine