1174636401 NPI number — CAROLYN COLETTE COCHRAN RD,LD,MS,CDE

Table of content: CAROLYN COLETTE COCHRAN RD,LD,MS,CDE (NPI 1174636401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174636401 NPI number — CAROLYN COLETTE COCHRAN RD,LD,MS,CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COCHRAN
Provider First Name:
CAROLYN
Provider Middle Name:
COLETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD,LD,MS,CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174636401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1420 VICEROY DR
Provider Second Line Business Mailing Address:
ATTN: LASHUNDA JOHNSON
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75235-2208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-358-2300
Provider Business Mailing Address Fax Number:
214-366-6127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3604 LIVE OAK ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75204-6168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-358-2300
Provider Business Practice Location Address Fax Number:
214-366-6330
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133VN1005X , with the licence number:  DT00622 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com