Organization
PHYSICIAN ASSIST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL JOHN COBB PA-C (OWNER)
(401) 265-4553
Entity
Organization
Contact information
Practice address
35 BROAD ROCK RD, WAKEFIELD, RI 02879-1872
(401) 265-4553
Mailing address
35 BROAD ROCK RD, WAKEFIELD, RI 02879-1872
(401) 265-4553
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA00255
RI
Other
Enumeration date
12/28/2009
Last updated
12/28/2009
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