Provider Demographics
NPI:1700384427
Name:COBB, STEPHEN EVERETT
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:EVERETT
Last Name:COBB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 NW 122ND ST APT 131
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8467
Mailing Address - Country:US
Mailing Address - Phone:405-510-8892
Mailing Address - Fax:
Practice Address - Street 1:2401 NW 122ND ST APT 131
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8467
Practice Address - Country:US
Practice Address - Phone:405-510-8892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator