Healthcare Provider Details

I. General information

NPI: 1124014865
Provider Name (Legal Business Name): JAYSON A COBLE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CARPENTER ST
SPRINGFIELD IL
62702-5324
US

IV. Provider business mailing address

3132 OLD JACKSONVILLE RD STE 110
SPRINGFIELD IL
62704-7401
US

V. Phone/Fax

Practice location:
  • Phone: 217-544-6464
  • Fax:
Mailing address:
  • Phone: 217-588-2600
  • Fax: 217-862-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085002176
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085002176
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: