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NPI Code Detail

MEDICARE: DR. MARY COBB DPM

MEDICARE: DR. MARY COBB DPM
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
1390200000XStudent in an Organized Health Care Education/Training Program
2213E00000XPodiatrist333207LA
3213E00000XPodiatrist016005825IL

General Provider Information

NPI Number : 1922454131
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY COBB DPM
Provider Business Mailing Address
First Line : 1108 PORT ARTHUR TER
Second Line :
City : LEESVILLE
State : LA
Zip : 71446-4600
Country : US
Telephone Number : 337-239-1061
Fax Number :
Provider Business Practice Location Address
First Line : 1108 PORT ARTHUR TER
Second Line :
City : LEESVILLE
State : LA
Zip : 71446-4600
Country : US
Telephone Number : 337-239-1061
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2016
Last Update Date : 12/02/2022

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