Provider Demographics
NPI:1194771899
Name:COBB, STEPHEN WAYNE (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WAYNE
Last Name:COBB
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 1:16570 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80023-8964
Mailing Address - Country:US
Mailing Address - Phone:303-689-6600
Mailing Address - Fax:303-689-6601
Practice Address - Street 1:16570 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80023-8964
Practice Address - Country:US
Practice Address - Phone:303-689-6600
Practice Address - Fax:303-689-6601
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87328542Medicaid
CO87328542Medicaid
COC800243Medicare PIN
G28724Medicare UPIN