Provider Demographics
NPI:1407899875
Name:COCHRAN, RONALD JAY (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JAY
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 1:1918 WEST LOOP
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437
Mailing Address - Country:US
Mailing Address - Phone:979-543-1800
Mailing Address - Fax:979-543-5931
Practice Address - Street 1:1918 WEST LOOP
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437
Practice Address - Country:US
Practice Address - Phone:979-543-1800
Practice Address - Fax:979-543-5931
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1461207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098823001Medicaid
C14575Medicare UPIN