Provider Demographics
NPI:1649359076
Name:COCHRAN, CHRISTOPHER D (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:D
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH SPRING
Mailing Address - State:AR
Mailing Address - Zip Code:72554-0477
Mailing Address - Country:US
Mailing Address - Phone:870-907-7024
Mailing Address - Fax:870-625-7045
Practice Address - Street 1:277 MAIN ST
Practice Address - Street 2:
Practice Address - City:MAMMOTH SPRING
Practice Address - State:AR
Practice Address - Zip Code:72554
Practice Address - Country:US
Practice Address - Phone:870-907-7024
Practice Address - Fax:870-907-7045
Is Sole Proprietor?:No
Enumeration Date:2006-11-05
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2472207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208397703Medicaid
AR142801001Medicaid
MOH36979Medicare UPIN
MO000095585Medicare ID - Type Unspecified