MEDICARE: DR. LEAH KATHLEEN COBB 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	207X00000X	Orthopaedic Surgery Physician	036162251	IL

General Provider Information

NPI Number	:	1891962197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEAH KATHLEEN COBB MD

Provider Business Mailing Address
First Line	:	PO BOX 6502
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00914-6502
Country	:	US
Telephone Number	:	787-222-5262
Fax Number	:	772-919-8543

Provider Business Practice Location Address
First Line	:	2619 W FAIRVIEW AVE
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-6722
Country	:	US
Telephone Number	:	208-706-2663
Fax Number	:	208-489-4300

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

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	03/18/2025

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