Provider Demographics
NPI:1649353558
Name:COCHRAN, DAVID KEITH (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KEITH
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:KEITH
Other - Last Name:COCHRAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:106 ALAN DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63361-2102
Mailing Address - Country:US
Mailing Address - Phone:573-564-6244
Mailing Address - Fax:573-564-6244
Practice Address - Street 1:106 ALAN DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY CITY
Practice Address - State:MO
Practice Address - Zip Code:63361-2102
Practice Address - Country:US
Practice Address - Phone:573-564-6244
Practice Address - Fax:573-564-6244
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100089207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F42779Medicare UPIN