Provider Demographics
NPI:1083614978
Name:COBOS, VICTOR L (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:L
Last Name:COBOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 FULTON ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2688
Mailing Address - Country:US
Mailing Address - Phone:940-382-2646
Mailing Address - Fax:940-384-1610
Practice Address - Street 1:1300 FULTON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2688
Practice Address - Country:US
Practice Address - Phone:940-382-2646
Practice Address - Fax:940-384-1610
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2014-04-01
Deactivation Date:2006-04-10
Deactivation Code:
Reactivation Date:2006-04-14
Provider Licenses
StateLicense IDTaxonomies
TXK8089174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2192502OtherAETNA
TX94515OtherAMERIGROUP
TX047495902Medicaid
TX8A7386OtherBLUE CROSS BLUE SHIELD
TX8A7386Medicare ID - Type Unspecified
TX2192502OtherAETNA