Provider Demographics
NPI:1851435598
Name:COBB, DAMON CHRISTOPHER (DO)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:CHRISTOPHER
Last Name:COBB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11939 RANCHO BERNARDO RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2074
Mailing Address - Country:US
Mailing Address - Phone:858-618-1156
Mailing Address - Fax:858-618-3314
Practice Address - Street 1:11939 RANCHO BERNARDO RD STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2074
Practice Address - Country:US
Practice Address - Phone:858-618-1156
Practice Address - Fax:858-618-3314
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003281A207V00000X
CA20A11368207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000603951OtherANTHEM
IN200829650ROtherMEDICAID GROUP
IN200965430AOtherMEDICAID GROUP-TELL CITY
KY7100071220Medicaid
IN200829650SOtherMEDICAID GROUP-VINCENNES
IN200930660Medicaid
IN000000603951OtherANTHEM