Provider Demographics
NPI:1639229594
Name:COBB, MATTHEW DAVIS (DPM)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAVIS
Last Name:COBB
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:8080 ACADEMY RD NE STE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1159
Mailing Address - Country:US
Mailing Address - Phone:505-247-4164
Mailing Address - Fax:505-247-4561
Practice Address - Street 1:8080 ACADEMY RD NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1159
Practice Address - Country:US
Practice Address - Phone:505-247-4164
Practice Address - Fax:505-247-4561
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAEL1620213ES0103X
NM325213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM6203220001Medicare NSC
NMNM302927Medicare PIN