Provider Demographics
NPI:1093863383
Name:COBLE, WESTON (PA)
Entity Type:Individual
Prefix:MR
First Name:WESTON
Middle Name:
Last Name:COBLE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 SUMMIT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3480
Mailing Address - Country:US
Mailing Address - Phone:510-869-8660
Mailing Address - Fax:
Practice Address - Street 1:3012 SUMMIT ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3480
Practice Address - Country:US
Practice Address - Phone:510-869-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13856363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical