MEDICARE: TOM L COBIAN LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MA00005370	WA

General Provider Information

NPI Number	:	1194032151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOM L COBIAN LMP

Provider Business Mailing Address
First Line	:	2422 E LOUISA ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98112-2234
Country	:	US
Telephone Number	:	206-669-4190
Fax Number	:

Provider Business Practice Location Address
First Line	:	2422 E LOUISA ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98112-2234
Country	:	US
Telephone Number	:	206-669-4190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2010
Last Update Date	:	10/08/2015

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