Provider Demographics
NPI:1487775771
Name:COBBOLD, CHRISTIAN M (MD)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:M
Last Name:COBBOLD
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 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-1981
Mailing Address - Fax:
Practice Address - Street 1:7125 MURRELL RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7999
Practice Address - Country:US
Practice Address - Phone:321-361-5595
Practice Address - Fax:321-259-0547
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF347YOtherMEDICARE
16208OtherBCBS OF FL
5305672OtherAETNA
FL279210900Medicaid
G37846Medicare UPIN
FL279210900Medicaid