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Individual

SELLAS PECOS COBLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
600 BLUES LAKE PKWY, ROLLA, MO 65401-8022
(573) 364-8822
(573) 202-2402
Mailing address
600 BLUES LAKE PKWY, ROLLA, MO 65401-8022
(573) 364-8822
(573) 202-2404

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
116667
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
110236209
RAILROAD MEDICARE
MO
01
143206
BLUE CROSS BLUE SHIELD OF
MO
05
245304902
MO
01
457663
HEALTHLINK
MO
01
P00063568
RAILROAD MEDICARE
MO
Enumeration date
07/18/2006
Last updated
09/15/2025
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