Organization
WEST COAST PATHOLOGY OF FLORIDA PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN MOBLEY MD (PRESIDENT)
(352) 596-6632
Entity
Organization
Contact information
Practice address
11375 CORTEZ BLVD, BROOKSVILLE, FL 34613-5409
(305) 665-4614
(770) 776-5966
Mailing address
PO BOX 60100, CHARLESTON, SC 29419-0100
(305) 665-4614
(770) 776-5966
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
058311100
—
FL
05
—
058311101
—
FL
01
—
77905
BLUE CROSS BLUE SHIELD
FL
01
—
77905A
BLUE CROSS BLUE SHIELD
FL
Enumeration date
06/21/2006
Last updated
07/25/2008
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