MEDICARE: BRIAN W COBBS N.P.

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	363LF0000X	Family Nurse Practitioner	RN124446 AND AP8640	AZ

General Provider Information

NPI Number	:	1205381969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN W COBBS N.P.

Provider Business Mailing Address
First Line	:	8634 E HILLVIEW ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-4119
Country	:	US
Telephone Number	:	928-606-9496
Fax Number	:

Provider Business Practice Location Address
First Line	:	5520 E MAIN ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85205-8793
Country	:	US
Telephone Number	:	480-832-1992
Fax Number	:	480-830-2402

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

Provider Enumeration Date	:	08/23/2016
Last Update Date	:	08/23/2016

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