Provider Demographics
NPI:1225272396
Name:COOBS, BENJAMIN RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:RAY
Last Name:COOBS
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 1:2331 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1111
Mailing Address - Country:US
Mailing Address - Phone:540-725-1226
Mailing Address - Fax:540-857-5306
Practice Address - Street 1:2331 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1111
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014004824207X00000X
VA0101258157207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1225272396OtherCIGNA
VA1225272396OtherUMWA
VA1225272396OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1225272396OtherHEALTHKEEPERS
VA1225272396OtherVIRGINIA HEALTH NETWORK
VA1225272396OtherUNITED HEALTHCARE
VA1225272396OtherAETNA
VA1225272396OtherOPTIMA HEALTH PLAN
VA1225272396OtherHUMANA MEDICARE
VA1225272396OtherMEDICAID
VA1225272396OtherANTHEM BCBS
VA1225272396OtherHEALTHKEEPERS PLUS
VA1225272396OtherINTOTAL
VA540506332199OtherTRICARE
VA1225272396OtherVIRGINIA PREMIER
VA1225272396OtherGATEWAY
VA1225272396OtherMEDICAID OF WVA
VAP01571876OtherRAILROAD MEDICARE
VA1225272396OtherGATEWAY