MEDICARE: DR. GWENDOLYN PATTERSON COBBS M.D.

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	207V00000X	Obstetrics & Gynecology Physician	101054118	VA
2	207VG0400X	Gynecology Physician	84806	SC

General Provider Information

NPI Number	:	1295794386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GWENDOLYN PATTERSON COBBS M.D.

Provider Business Mailing Address
First Line	:	5046 HIGHWAY 17 BYP S STE 202
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-4503
Country	:	US
Telephone Number	:	843-293-0466
Fax Number	:	843-293-0534

Provider Business Practice Location Address
First Line	:	5046 HIGHWAY 17 BYP S STE 202
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-4503
Country	:	US
Telephone Number	:	843-293-0466
Fax Number	:	843-293-0534

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

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	03/07/2024

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