Provider Demographics
NPI:1730322405
Name:COBB, HEATH AARON (MD)
Entity type:Individual
Prefix:DR
First Name:HEATH
Middle Name:AARON
Last Name:COBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-387-4500
Mailing Address - Fax:801-475-1621
Practice Address - Street 1:4403 HARRISON BLVD
Practice Address - Street 2:STE 4875
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3271
Practice Address - Country:US
Practice Address - Phone:801-387-4500
Practice Address - Fax:801-475-1621
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60929411208000000X
UT8273584-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000076467Medicare PIN