Provider Demographics
NPI:1487748976
Name:BARKSDALE, COBB R III (MD)
Entity type:Individual
Prefix:
First Name:COBB
Middle Name:R
Last Name:BARKSDALE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6940 WINTON BLOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117
Mailing Address - Country:US
Mailing Address - Phone:334-279-9211
Mailing Address - Fax:334-279-9925
Practice Address - Street 1:6940 WINTON BLOUNT BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117
Practice Address - Country:US
Practice Address - Phone:334-279-9211
Practice Address - Fax:334-279-9925
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL7124207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51507672OtherBCBS
ALAB6111114OtherDEA LICENSE
C73024Medicare UPIN