Provider Demographics
NPI:1710373428
Name:COBB, STEPHANIE LYONS (DO)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYONS
Last Name:COBB
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MARIE
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 W 38TH ST STE 403
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1013
Mailing Address - Country:US
Mailing Address - Phone:512-459-0301
Mailing Address - Fax:512-459-9701
Practice Address - Street 1:1301 W 38TH ST STE 403
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1013
Practice Address - Country:US
Practice Address - Phone:512-459-0301
Practice Address - Fax:512-459-9701
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS5144207RI0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX416526801Medicaid