Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | LL9884 | MD |
NPI | 1003470485 |
---|---|
Provider Name | Sheryse Desiree Mobley |
First Address | Killeen, TX 76543-5069 |
Second Address | Baltimore, MD 21201-1524 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2019 |
Last Update Date | 25/05/2019 |