Provider Demographics
NPI:1932118478
Name:COCKERHAM, GLENN COOPER (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:COOPER
Last Name:COCKERHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:220 ROBIN RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:CA
Mailing Address - Zip Code:94010-6634
Mailing Address - Country:US
Mailing Address - Phone:650-858-3908
Mailing Address - Fax:650-496-2502
Practice Address - Street 1:3801 MIRANDA AVENUE
Practice Address - Street 2:VA PALO ALTO, OPHTHALMOLOGY SECTION 112-B1
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304
Practice Address - Country:US
Practice Address - Phone:650-858-3908
Practice Address - Fax:650-496-2502
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC51248207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology