Active NPI
Mark Thomas Moberg, MD
- Ophthalmology Physician
- Saint Cloud, MN
National Provider Identifier
1609814920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 20295
- Practice address
- 109 Doctors Park
Saint Cloud, MN 56303 - Phone
- (320) 253-3637
- Fax
- (320) 253-5412
- NPI assigned
- Jun 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 20295 | MN | Primary |
Addresses
Primary practice location
109 Doctors Park
Saint Cloud, MN 56303
Mailing address
109 Doctors Park
Saint Cloud, MN 56303
Phone (320) 253-3637
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20295 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346371200000",
"number": "1609814920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 DOCTORS PARK",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "56303",
"telephone_number": "320-253-3637",
"fax_number": "320-253-5412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 DOCTORS PARK",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "56303",
"telephone_number": "320-253-3637",
"fax_number": "320-253-5412"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOBERG",
"first_name": "MARK",
"middle_name": "THOMAS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-02",
"last_updated": "2012-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "MN",
"license": "20295",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.