=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386668481
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUTHER F COBB M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2006
-----------------------------------------------------
Last Update Date | 02/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 636 HARRIS ST STE A
-----------------------------------------------------
City | EUREKA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95503-4448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-476-0688
-----------------------------------------------------
Fax | 707-476-0692
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 990208
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96099-0208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-212-0073
-----------------------------------------------------
Fax | 844-440-2311
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number | G42522
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------