Provider Demographics
NPI:1770502163
Name:COBB, CULLY ALTON III (MD)
Entity Type:Individual
Prefix:DR
First Name:CULLY
Middle Name:ALTON
Last Name:COBB
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3939 J ST
Practice Address - Street 2:SUITE 250
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3636
Practice Address - Country:US
Practice Address - Phone:916-733-3401
Practice Address - Fax:916-733-3410
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG19193207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G191930Medicaid
A40559Medicare UPIN
CA00G191930Medicare PIN