Provider Demographics
NPI:1871565655
Name:COBB, ROBERT C (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:COBB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9716 REVERSIDE PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137
Mailing Address - Country:US
Mailing Address - Phone:918-299-4333
Mailing Address - Fax:918-299-4330
Practice Address - Street 1:9716 REVERSIDE PKWY
Practice Address - Street 2:STE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137
Practice Address - Country:US
Practice Address - Phone:918-299-4333
Practice Address - Fax:918-299-4330
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2013-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK2014207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100231190AMedicaid
OK$$$$$$$$$-007OtherBLUE CROSS-CLAREMORE
OK$$$$$$$$$-006OtherBLUE CROSS-OWASSO
OK100231190AMedicaid
OK249302803Medicare PIN
OK$$$$$$$$$-007OtherBLUE CROSS-CLAREMORE
OKD38702Medicare UPIN