Provider Demographics
NPI:1053157602
Name:COBBS, SETH GORDON
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:GORDON
Last Name:COBBS
Suffix:
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 1:114 SCENIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-1343
Mailing Address - Country:US
Mailing Address - Phone:330-599-8877
Mailing Address - Fax:
Practice Address - Street 1:114 SCENIC VIEW DR
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-1343
Practice Address - Country:US
Practice Address - Phone:330-599-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver