Healthcare Provider Details

I. General information

NPI: 1184631459
Provider Name (Legal Business Name): COBY J PHILLIPS P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W 40TH ST
AUSTIN TX
78756-4010
US

IV. Provider business mailing address

1010 W 40TH ST
AUSTIN TX
78756-4010
US

V. Phone/Fax

Practice location:
  • Phone: 512-459-8753
  • Fax: 512-483-6807
Mailing address:
  • Phone: 512-459-8753
  • Fax: 512-483-6807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA03814
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA03814
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: