Healthcare Provider Details

I. General information

NPI: 1023281441
Provider Name (Legal Business Name): WILLIAM J. COBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W PENNSYLVANIA AVE
ANACONDA MT
59711-1900
US

IV. Provider business mailing address

305 W PENNSYLVANIA AVE
ANACONDA MT
59711-1900
US

V. Phone/Fax

Practice location:
  • Phone: 406-563-8571
  • Fax: 406-563-4930
Mailing address:
  • Phone: 406-563-8571
  • Fax: 406-563-4930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2011016836
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number14432A
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number32329
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: