MEDICARE: DR. LOWELL EDMUND KOBRIN PHD MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	MD11272	OR
2	171100000X	Acupuncturist	MD11272	OR

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CB3544	OTHER	OR	RR MEDICARE GROUP NUMBER
2	P00389909	OTHER	OR	RR MEDICARE PTAN NUMBER
3	R0000WFBTV	OTHER	OR	MEDICARE GROUP PIN NUMBER

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	1407812365	OTHER	OR	NBMC NPI NUMBER-GROUP
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1578547139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOWELL EDMUND KOBRIN PHD MD

Provider Business Mailing Address
First Line	:	1900 WOODLAND DR
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-0000
Country	:	US
Telephone Number	:	541-267-5151
Fax Number	:	541-266-0191

Provider Business Practice Location Address
First Line	:	1900 WOODLAND DR
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-0000
Country	:	US
Telephone Number	:	541-267-5151
Fax Number	:	541-266-0191

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	04/14/2010

1900 WOODLAND DRIVE
COOS BAY, OR
97420-0000

Practice Phone: 541-267-5151
Practice Fax: 541-266-4553