Provider Demographics
NPI:1972745230
Name:MOBERG, PHILIP EMERSON (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:EMERSON
Last Name:MOBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10330 MERIDIAN AVE N
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9451
Mailing Address - Country:US
Mailing Address - Phone:206-368-6123
Mailing Address - Fax:206-368-6178
Practice Address - Street 1:10330 MERIDIAN AVE N
Practice Address - Street 2:SUITE 250
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9451
Practice Address - Country:US
Practice Address - Phone:206-368-6123
Practice Address - Fax:206-368-6178
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA94684207R00000X, 207RR0500X
WAMD00048521207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine