Provider Demographics
NPI:1679505739
Name:COBB, JAMES ROBERT JR (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:COBB
Suffix:JR
Gender:M
Credentials:DO
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 490
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39649-0490
Mailing Address - Country:US
Mailing Address - Phone:601-249-2701
Mailing Address - Fax:601-249-2195
Practice Address - Street 1:215 MARION AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2705
Practice Address - Country:US
Practice Address - Phone:601-249-5500
Practice Address - Fax:601-249-1173
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO450207R00000X
MS15317207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL543420007Medicaid
MS00118568Medicaid
ALJ114-J460Medicare PIN
AL051519617Medicare ID - Type Unspecified
AL013420Medicare Oscar/Certification
MS410392YQVYMedicare PIN
G08664Medicare UPIN
ALG08664Medicare UPIN