MEDICARE: EMILY A COBERLY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	2006010965	MO
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	2006010965	MO
3	207ZB0001X	Blood Banking & Transfusion Medicine Physician	2006010965	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	211431	OTHER	MO	BLUE SHIELD
3	758219	OTHER	MO	HEALTHLINK

General Provider Information

NPI Number	:	1154423200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY A COBERLY MD

Provider Business Mailing Address
First Line	:	PO BOX 843966
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64184-3966
Country	:	US
Telephone Number	:	573-884-3300
Fax Number	:	573-884-0943

Provider Business Practice Location Address
First Line	:	4050 LINDELL BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-3297
Country	:	US
Telephone Number	:	314-396-9363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	01/28/2020

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Directions to “ EMILY A COBERLY MD” Practice Location

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