Provider Demographics
NPI:1578659132
Name:WILLIAM C. COBB, M.D., P.A.
Entity Type:Organization
Organization Name:WILLIAM C. COBB, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-523-9400
Mailing Address - Street 1:1117 MCLAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72112
Mailing Address - Country:US
Mailing Address - Phone:870-523-9400
Mailing Address - Fax:870-523-9002
Practice Address - Street 1:1117 MCLAIN STREET
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112
Practice Address - Country:US
Practice Address - Phone:870-523-9400
Practice Address - Fax:870-523-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I20536Medicare UPIN