Basic Information
| Provider Information | |||||||||
| NPI: | 1912005505 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOBLEY | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4400 BAYOU BLVD | ||||||||
| Address2: | SUITE 51 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325032673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504847775 | ||||||||
| FaxNumber: | 8504848874 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 W LAKEVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325011836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504693500 | ||||||||
| FaxNumber: | 8504848874 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 11/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | ME49534 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.