Provider Demographics
NPI:1952339459
Name:COBB, JEANNINE M (MD)
Entity type:Individual
Prefix:
First Name:JEANNINE
Middle Name:M
Last Name:COBB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:900 W MYRTLE ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-3242
Mailing Address - Country:US
Mailing Address - Phone:620-332-5874
Mailing Address - Fax:620-332-5877
Practice Address - Street 1:900 W MYRTLE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-3242
Practice Address - Country:US
Practice Address - Phone:620-332-5874
Practice Address - Fax:620-332-5877
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2013-04-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS23325207V00000X
KS04-23325207VB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VB0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObesity Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS023427OtherBCBS
KS200109OtherHPK
KS12149509OtherMULTIPLAN
KS2256OtherPHS
KS100132220AMedicaid
KS16883OtherCOVENTRY
KS12149509OtherMULTIPLAN
KS16883OtherCOVENTRY