Provider Demographics
NPI:1003085937
Name:WM MICHAEL COCHRAN MD PLLC
Entity Type:Organization
Organization Name:WM MICHAEL COCHRAN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN, OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-989-3521
Mailing Address - Street 1:4050 N CIRCULO MANZANILLO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-1879
Mailing Address - Country:US
Mailing Address - Phone:520-989-3521
Mailing Address - Fax:520-989-3522
Practice Address - Street 1:140 W DUVAL MINE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-5000
Practice Address - Country:US
Practice Address - Phone:520-989-3521
Practice Address - Fax:520-989-3522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ15469208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z106726OtherMEDICARE INDIVIDUAL PIN
AZAZ15469OtherSTATE LICENSE NUMBER
1467404319OtherTYPE I NPI
AZAZ15469OtherSTATE LICENSE NUMBER
Z106543Medicare PIN