Provider Demographics
NPI:1235119298
Name:COCKERELL, CLAY J (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAY
Middle Name:J
Last Name:COCKERELL
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 1:2110 RESEARCH ROW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-2519
Mailing Address - Country:US
Mailing Address - Phone:214-530-5200
Mailing Address - Fax:214-530-5230
Practice Address - Street 1:2110 RESEARCH ROW
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-2519
Practice Address - Country:US
Practice Address - Phone:214-530-5200
Practice Address - Fax:214-530-5230
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9311207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13737106Medicaid
TX0019AYOtherBLUE CROSS
TXA63878Medicare UPIN
TX13737106Medicaid