Provider Demographics
NPI:1215164629
Name:COBB, JASON B (MD)
Entity type:Individual
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First Name:JASON
Middle Name:B
Last Name:COBB
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1400 OLD FORGE DR
Mailing Address - Street 2:# 304
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-5500
Mailing Address - Country:US
Mailing Address - Phone:870-541-6000
Mailing Address - Fax:870-541-3198
Practice Address - Street 1:4010 S MULBERRY ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7000
Practice Address - Country:US
Practice Address - Phone:870-541-6000
Practice Address - Fax:870-541-3198
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2015-03-17
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Provider Licenses
StateLicense IDTaxonomies
ARE8567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR206364001Medicaid