Provider Demographics
NPI:1982040010
Name:MOBLEY MD FACIAL PLASTIC AND RECONSTRUCTIVE SURGERY, PLLC
Entity Type:Organization
Organization Name:MOBLEY MD FACIAL PLASTIC AND RECONSTRUCTIVE SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-449-9990
Mailing Address - Street 1:5292 S COLLEGE DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2958
Mailing Address - Country:US
Mailing Address - Phone:801-449-4490
Mailing Address - Fax:801-293-8101
Practice Address - Street 1:5292 S COLLEGE DR
Practice Address - Street 2:SUITE 303
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-2958
Practice Address - Country:US
Practice Address - Phone:801-449-4490
Practice Address - Fax:801-293-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5133249-1205207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty