Provider Demographics
NPI:1225002256
Name:COCKERHAM, WALTER D (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:D
Last Name:COCKERHAM
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 1:2820 NAPOLEON AVE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6969
Mailing Address - Country:US
Mailing Address - Phone:504-895-5959
Mailing Address - Fax:504-895-5987
Practice Address - Street 1:2820 NAPOLEON AVE
Practice Address - Street 2:SUITE 900
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6969
Practice Address - Country:US
Practice Address - Phone:504-895-5959
Practice Address - Fax:504-895-5987
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008197207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1028452Medicaid
B60715Medicare UPIN
LA5K075Medicare ID - Type Unspecified