Provider Demographics
NPI:1710972336
Name:COBB, LOREN MASON (MD)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:MASON
Last Name:COBB
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3013 S 363RD ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7249
Mailing Address - Country:US
Mailing Address - Phone:509-991-8589
Mailing Address - Fax:253-835-5761
Practice Address - Street 1:3013 S 363RD ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7249
Practice Address - Country:US
Practice Address - Phone:509-991-8589
Practice Address - Fax:253-835-5761
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2014-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA300472086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAB48462Medicare UPIN