Provider Demographics
NPI:1952382483
Name:MOBLEY, HARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:
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 1:417 SOUTHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-8391
Mailing Address - Country:US
Mailing Address - Phone:318-798-3627
Mailing Address - Fax:318-932-2186
Practice Address - Street 1:3342 BIENVILLE RD
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:LA
Practice Address - Zip Code:71068-3242
Practice Address - Country:US
Practice Address - Phone:318-894-3644
Practice Address - Fax:318-932-2186
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011669208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1146242Medicaid
LA1146242Medicaid
LAB64488Medicare UPIN
LA53261CP64Medicare PIN
LA53261CP62Medicare PIN