Provider Demographics
NPI:1417991811
Name:COCHRANE, DOUGLAS MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MATTHEW
Last Name:COCHRANE
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 60038
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-6038
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:5451 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2609
Practice Address - Country:US
Practice Address - Phone:909-464-8666
Practice Address - Fax:909-464-8913
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76957207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G769570Medicaid
CA00G769570Medicare ID - Type Unspecified
CAWG76957JMedicare PIN
CAF73590Medicare UPIN
CA00G769570Medicaid