Provider Demographics
NPI:1497745608
Name:COBB, GARY ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ARTHUR
Last Name:COBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4040 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-6619
Mailing Address - Country:US
Mailing Address - Phone:513-424-0941
Mailing Address - Fax:513-424-9758
Practice Address - Street 1:4040 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-6619
Practice Address - Country:US
Practice Address - Phone:513-424-0941
Practice Address - Fax:513-424-9758
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053093208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0733362Medicaid
OH0733362Medicaid
OHCO0630031Medicare ID - Type Unspecified