MEDICARE: LINDA M COBLE ED.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	103TC0700X	Clinical Psychologist	PSY424	NM

General Provider Information

NPI Number	:	1740206432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA M COBLE ED.D.

Provider Business Mailing Address
First Line	:	8600 ACADEMY RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-1107
Country	:	US
Telephone Number	:	505-821-3628
Fax Number	:	505-856-7103

Provider Business Practice Location Address
First Line	:	4601 JUAN TABO BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2626
Country	:	US
Telephone Number	:	505-821-3628
Fax Number	:	505-856-7103

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	09/28/2018

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