MEDICARE: DR. FREDERICK EDMUND COBB PH.D. CCC-A

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	231H00000X	Audiologist	AY388	FL

General Provider Information

NPI Number	:	1598710394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK EDMUND COBB PH.D. CCC-A

Provider Business Mailing Address
First Line	:	PO BOX 551
Second Line	:
City	:	BAY PINES
State	:	FL
Zip	:	33744-0551
Country	:	US
Telephone Number	:	727-398-6661
Fax Number	:	727-319-1209

Provider Business Practice Location Address
First Line	:	10000 BAY PINES BLVD
Second Line	:	AUDIOLOGY (126) BPHCS (516)
City	:	BAY PINES
State	:	FL
Zip	:	33744-5005
Country	:	US
Telephone Number	:	727-398-6661
Fax Number	:	727-319-1209

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/08/2007

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