Provider Demographics
NPI:1801855986
Name:COBARRUBIAS, SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:COBARRUBIAS
Suffix:
Gender:M
Credentials:MD
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 28
Mailing Address - Street 2:
Mailing Address - City:HOMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31634-0028
Mailing Address - Country:US
Mailing Address - Phone:912-487-1654
Mailing Address - Fax:912-487-1659
Practice Address - Street 1:180 CARSWELL ST
Practice Address - Street 2:
Practice Address - City:HOMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31634-2413
Practice Address - Country:US
Practice Address - Phone:912-487-1654
Practice Address - Fax:912-487-1659
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2015-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045748207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000808519AMedicaid
GA000808519AMedicaid
GAG85433Medicare UPIN