Provider Demographics
NPI:1801836028
Name:COCHRUM, BRETT (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:COCHRUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6108 OAKBEND TRL STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3917
Mailing Address - Country:US
Mailing Address - Phone:817-294-4959
Mailing Address - Fax:817-294-1324
Practice Address - Street 1:6108 OAKBEND TRL STE 102
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3917
Practice Address - Country:US
Practice Address - Phone:817-294-4959
Practice Address - Fax:817-294-1324
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
45D1072789OtherCLIA
TXP00463690OtherMEDICARE RR PTAN
TXDG9427OtherMEDICARE RR GROUP
TX133752906Medicaid
TX133752906Medicaid
TXC14579Medicare UPIN
TXP00463690OtherMEDICARE RR PTAN
TX133752906Medicaid