Provider Demographics
NPI:1528297819
Name:COBBINS, WALTER JR
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:
Last Name:COBBINS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 DEVON RD
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-5204
Mailing Address - Country:US
Mailing Address - Phone:985-652-6666
Mailing Address - Fax:985-652-6666
Practice Address - Street 1:102 DEVON RD
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-5204
Practice Address - Country:US
Practice Address - Phone:985-652-6666
Practice Address - Fax:985-652-6666
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor