Provider Demographics
NPI:1801864871
Name:COCHRANE, MATTHEW DONALD (IDC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DONALD
Last Name:COCHRANE
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31133 EUCLID LOOP
Mailing Address - Street 2:
Mailing Address - City:FRENCH VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92596
Mailing Address - Country:US
Mailing Address - Phone:858-577-9968
Mailing Address - Fax:
Practice Address - Street 1:19871 BAUER RD
Practice Address - Street 2:BRANCH MEDICAL CLINIC MCAS MIRAMAR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92145
Practice Address - Country:US
Practice Address - Phone:858-577-9968
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman