Healthcare Provider Details

I. General information

NPI: 1215164629
Provider Name (Legal Business Name): JASON B COBB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 S MULBERRY ST
PINE BLUFF AR
71603-7000
US

IV. Provider business mailing address

1400 OLD FORGE DR # 304
LITTLE ROCK AR
72227-5500
US

V. Phone/Fax

Practice location:
  • Phone: 870-541-6000
  • Fax: 870-541-3198
Mailing address:
  • Phone: 870-541-6000
  • Fax: 870-541-3198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE8567
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: