Healthcare Provider Details

I. General information

NPI: 1710373428
Provider Name (Legal Business Name): STEPHANIE LYONS COBB D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE MARIE LYONS

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 38TH ST STE 403
AUSTIN TX
78705-1013
US

IV. Provider business mailing address

1301 W 38TH ST STE 403
AUSTIN TX
78705-1013
US

V. Phone/Fax

Practice location:
  • Phone: 512-459-0301
  • Fax: 512-459-9701
Mailing address:
  • Phone: 512-459-0301
  • Fax: 512-459-9701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberS5144
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: