Provider Demographics
NPI:1194032151
Name:COBIAN, TOM L (LMP)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:L
Last Name:COBIAN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 E LOUISA ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-2234
Mailing Address - Country:US
Mailing Address - Phone:206-669-4190
Mailing Address - Fax:
Practice Address - Street 1:2422 E LOUISA ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-2234
Practice Address - Country:US
Practice Address - Phone:206-669-4190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005370174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist