Provider Demographics
NPI:1275584690
Name:COBB, WILLIAM C (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:COBB
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 1:414 MALLARD CV
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72112-4697
Mailing Address - Country:US
Mailing Address - Phone:870-523-5226
Mailing Address - Fax:870-523-9002
Practice Address - Street 1:1117 MCLAIN ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-3500
Practice Address - Country:US
Practice Address - Phone:870-523-9400
Practice Address - Fax:870-523-9002
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25644207R00000X
ARE-4832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51531088OtherBCBS
MS02780831Medicaid
AL51530937OtherBCBS
I20536Medicare UPIN