Provider Demographics
NPI:1821433681
Name:COCHRAN, CASEY L (DO)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:L
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 S GULPH RD
Mailing Address - Street 2:ATN :IPM CREDENTIALING
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:484-913-7467
Mailing Address - Fax:610-878-3965
Practice Address - Street 1:1900 W WILLOW RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-2441
Practice Address - Country:US
Practice Address - Phone:580-249-3782
Practice Address - Fax:580-599-6446
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5541207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine