MEDICARE: DR. DARCEY GUS KOBS III 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	208D00000X	General Practice Physician	H8180	TX
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	H8180	TX

General Provider Information

NPI Number	:	1720094782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARCEY GUS KOBS III M.D.

Provider Business Mailing Address
First Line	:	4122 1/2 DRAKE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-1028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6535 SW FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-2207
Country	:	US
Telephone Number	:	713-981-8184
Fax Number	:	713-981-8118

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	12/14/2011

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