Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 5725 | SD |
Y | 208200000X | Surgeon | CA286A | CA |
Y | 208600000X | Surgeon | CA286A | CA |
NPI | 1528034212 |
---|---|
Provider Name | Elijah Mobley |
First Address | Apple Valley, CA 92307-6197 |
Second Address | Victorville, CA 92395-3727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 17/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6631230 | (05) | SD |
H50793 | (02) | SD |