Basic Information
| Provider Information | |||||||||
| NPI: | 1487895082 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOBERLY HBP MEDICAL GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1515 UNION AVE | ||||||||
| Address2: | |||||||||
| City: | MOBERLY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652709407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6602638400 | ||||||||
| FaxNumber: | 6602692993 | ||||||||
| Practice Location | |||||||||
| Address1: | 1515 UNION AVE | ||||||||
| Address2: | |||||||||
| City: | MOBERLY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652709407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6602638400 | ||||||||
| FaxNumber: | 6602692993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2009 | ||||||||
| LastUpdateDate: | 03/12/2009 | ||||||||
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| AuthorizedOfficialLastName: | BREWER | ||||||||
| AuthorizedOfficialFirstName: | DEBBIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8778929813 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.