1881705523 NPI number — JOHN COCHRAN MD

Table of content: JOHN COCHRAN MD (NPI 1881705523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881705523 NPI number — JOHN COCHRAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COCHRAN
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1881705523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18350 N MCLEOD WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83714-8863
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-229-0729
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5950 UNIVERSITY AVE STE 341
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-875-9800
Provider Business Practice Location Address Fax Number:
515-875-9804
Provider Enumeration Date:
08/31/2006

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: 208800000X , with the licence number:  M-12670 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: MD60515618 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: J5291 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: MD-46379 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2039604 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1881705523 . This is a "IPN" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 1881705523 . This is a "FCHN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1881705523 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8G8737 . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 115421304 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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