Provider Demographics
NPI:1619053287
Name:MOBLEY, GILBERT LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:LOUIS
Last Name:MOBLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 S WOODFIELD PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2279
Mailing Address - Country:US
Mailing Address - Phone:417-848-6100
Mailing Address - Fax:
Practice Address - Street 1:1308 N GLENSTONE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2130
Practice Address - Country:US
Practice Address - Phone:417-864-4100
Practice Address - Fax:417-863-8697
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4D98261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOD30270Medicare UPIN