Healthcare Provider Details

I. General information

NPI: 1255525838
Provider Name (Legal Business Name): ANDREW L. COBLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 N SPRING STREET
HARRISON AR
72601-2952
US

IV. Provider business mailing address

PO BOX 1116
HARRISON AR
72602-1116
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-6418
  • Fax: 870-741-5071
Mailing address:
  • Phone: 870-741-6418
  • Fax: 870-741-5071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE-7409
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: