Healthcare Provider Details

I. General information

NPI: 1871565655
Provider Name (Legal Business Name): ROBERT C COBB DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9716 REVERSIDE PKWY STE 100
TULSA OK
74137
US

IV. Provider business mailing address

9716 REVERSIDE PKWY STE 100
TULSA OK
74137
US

V. Phone/Fax

Practice location:
  • Phone: 918-299-4333
  • Fax: 918-299-4330
Mailing address:
  • Phone: 918-299-4333
  • Fax: 918-299-4330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2014
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: