MEDICARE: PEGGY RUTH COBB CNM

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	176B00000X	Midwife

General Provider Information

NPI Number	:	1467461624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEGGY RUTH COBB CNM

Provider Business Mailing Address
First Line	:	6441 W 81ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74131-3432
Country	:	US
Telephone Number	:	918-224-1605
Fax Number	:	918-224-1605

Provider Business Practice Location Address
First Line	:	6441 W 81ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74131-3432
Country	:	US
Telephone Number	:	918-224-1605
Fax Number	:	918-224-1605

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/12/2012

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