Provider Demographics
NPI:1669455846
Name:COBB, JOHN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:COBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 54136
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79453-4136
Mailing Address - Country:US
Mailing Address - Phone:806-771-1386
Mailing Address - Fax:806-771-1388
Practice Address - Street 1:6502 SLIDE RD
Practice Address - Street 2:SUITE 311
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-1329
Practice Address - Country:US
Practice Address - Phone:806-791-5100
Practice Address - Fax:806-793-4780
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL60132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162725901Medicaid
TX138909100OtherFIRSTCARE
TX8M2230OtherBLUECROSS BLUESHIELD
TXH83853Medicare UPIN
TX8B3194Medicare PIN