Provider Demographics
NPI:1861495723
Name:MOBLEY, DAVID WINTON (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WINTON
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 1:5101 GATE PARKWAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7276
Mailing Address - Country:US
Mailing Address - Phone:904-396-1186
Mailing Address - Fax:904-396-0228
Practice Address - Street 1:5101 GATE PARKWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7276
Practice Address - Country:US
Practice Address - Phone:904-396-1186
Practice Address - Fax:904-396-0228
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-09-01
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
FLME0020849208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD58269Medicare UPIN
71985Medicare PIN
FL71985Medicare ID - Type Unspecified