Provider Demographics
NPI:1457430381
Name:COCKING, STEVEN M (PAC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:COCKING
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 E INDIAN SCHOOL RD
Mailing Address - Street 2:STE 21-562
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5360
Mailing Address - Country:US
Mailing Address - Phone:480-545-2610
Mailing Address - Fax:480-545-2673
Practice Address - Street 1:4340 E INDIAN SCHOOL RD
Practice Address - Street 2:STE 21-562
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-5360
Practice Address - Country:US
Practice Address - Phone:480-545-2610
Practice Address - Fax:480-545-2673
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2054363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS43066Medicare UPIN