Basic Information
| Provider Information | |||||||||
| NPI: | 1780020271 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | COBB | ||||||||
| FirstName: | AMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 734812 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753734812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103589500 | ||||||||
| FaxNumber: | 2103589183 | ||||||||
| Practice Location | |||||||||
| Address1: | 1055 ADA ST | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103585515 | ||||||||
| FaxNumber: | 2103585530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2013 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | R3054 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | R3054 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | BP10046577 | 01 | TX | TEXAS MEDICAL BOARD PERMIT NUMBER | OTHER | 7004814074 | 01 | TX | ACGME PROGRAM ID | OTHER | 574036 | 01 | TX | TEXAS MEDICAL BOARD ID | OTHER |