Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 13318 | TX |
NPI | 1063422301 |
---|---|
Provider Name | Dr. George W Cobb JR. |
First Address | Houston, TX 77069-2650 |
Second Address | Houston, TX 77069-2650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 08/07/2007 |