MEDICARE: KELLY L. COBB 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	207R00000X	Internal Medicine Physician	33871	IA

General Provider Information

NPI Number	:	1598732349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY L. COBB M.D.

Provider Business Mailing Address
First Line	:	1405 W PINHOOK RD
Second Line	:	STE 102
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-3100
Country	:	US
Telephone Number	:	337-266-9985
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 W PINHOOK RD
Second Line	:	STE 102
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-3100
Country	:	US
Telephone Number	:	337-266-9985
Fax Number	:

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	03/07/2023

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