Provider Demographics
NPI:1386668481
Name:COBB, LUTHER F (MD)
Entity Type:Individual
Prefix:
First Name:LUTHER
Middle Name:F
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:PO BOX 990208
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-0208
Mailing Address - Country:US
Mailing Address - Phone:530-212-0073
Mailing Address - Fax:844-440-2311
Practice Address - Street 1:636 HARRIS ST STE A
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4448
Practice Address - Country:US
Practice Address - Phone:707-476-0688
Practice Address - Fax:707-476-0692
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG425222086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G425221Medicaid
CAA49002Medicare UPIN
CA00G425220Medicare ID - Type Unspecified