Provider Demographics
NPI:1235243783
Name:COCJIN, JUAN T (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:T
Last Name:COCJIN
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1860
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:2600 E BERRY ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105-4750
Practice Address - Country:US
Practice Address - Phone:817-347-4600
Practice Address - Fax:817-347-4639
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7453208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170994101Medicaid
TX4612674OtherAETNA PIN
1235462870OtherGROUP NPI
TX1069822OtherFIRSTHEALTH PIN
TX115322OtherSUPERIOR PIN
TX8Z1875OtherBCBSTX IND PIN
1174859375OtherGROUP NPI
TX10024496OtherAMERIGROUP PIN
TX0003GSOtherBCBSTX GRP PIN
TX138382015Medicaid
TX138382017Medicaid
TX134516100OtherFIRSTCARE PIN
TX7251916OtherCIGNA PIN
TX115322OtherSUPERIOR PIN
TX8Z1875OtherBCBSTX IND PIN