Provider Demographics
NPI:1053326496
Name:COCHRAN, TERRY WESLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:WESLEY
Last Name:COCHRAN
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 1:2000B SOUTH MAIN ST
Mailing Address - Street 2:P.O. BOX 1507
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-3740
Mailing Address - Country:US
Mailing Address - Phone:641-472-4156
Mailing Address - Fax:641-472-9436
Practice Address - Street 1:2000B SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-3740
Practice Address - Country:US
Practice Address - Phone:641-472-4156
Practice Address - Fax:641-472-9436
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1030676Medicaid
IA27519OtherWELLMARK PIN
IA27519OtherWELLMARK PIN
IA1030676Medicaid