Provider Demographics
NPI:1407225295
Name:JASON D COBB MD LLC
Entity Type:Organization
Organization Name:JASON D COBB MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:D
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-884-7700
Mailing Address - Street 1:7063 VETERANS PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35125-5114
Mailing Address - Country:US
Mailing Address - Phone:205-884-7700
Mailing Address - Fax:205-884-7602
Practice Address - Street 1:7063 VETERANS PKWY
Practice Address - Street 2:STE 200
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-5114
Practice Address - Country:US
Practice Address - Phone:205-884-7700
Practice Address - Fax:205-884-7602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102G708177OtherMEDICARE