MEDICARE: DR. STEPHANIE W COBBLE MD

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	207Q00000X	Family Medicine Physician	21221	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841254612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE W COBBLE MD

Provider Business Mailing Address
First Line	:	4500 S 129TH EAST AVE
Second Line	:	SUITE 191
City	:	TULSA
State	:	OK
Zip	:	74134-5801
Country	:	US
Telephone Number	:	918-779-7472
Fax Number	:	918-779-7456

Provider Business Practice Location Address
First Line	:	4500 S 129TH EAST AVE
Second Line	:	SUITE 191
City	:	TULSA
State	:	OK
Zip	:	74134-5801
Country	:	US
Telephone Number	:	918-779-7472
Fax Number	:	918-779-7456

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	04/28/2015

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