Provider Demographics
NPI:1205194313
Name:COBB, GILBERT D (MED)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:D
Last Name:COBB
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 NE 25TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-7939
Mailing Address - Country:US
Mailing Address - Phone:405-427-1591
Mailing Address - Fax:
Practice Address - Street 1:816 NE 25TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-7939
Practice Address - Country:US
Practice Address - Phone:405-427-1591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor