Provider Demographics
NPI:1710030689
Name:COCHRAN, BRADLEY M (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:M
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:PO BOX 680949
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-1610
Mailing Address - Country:US
Mailing Address - Phone:256-997-2189
Mailing Address - Fax:256-638-7445
Practice Address - Street 1:200 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968
Practice Address - Country:US
Practice Address - Phone:256-997-2189
Practice Address - Fax:256-638-7445
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL217162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009941342Medicaid
AL051501857OtherBC BS OF AL
AL051501857Medicaid
AL515-39183OtherBC BS OF AL
AL051501857OtherBC BS OF AL
ALH20258Medicare UPIN
AL009941342Medicaid