Provider Demographics
NPI:1811122641
Name:COCKRILL, TONYA C (MD)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:C
Last Name:COCKRILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:CHRISTINE
Other - Last Name:TRIBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 VISION PARK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3011
Mailing Address - Country:US
Mailing Address - Phone:936-273-5214
Mailing Address - Fax:936-273-5454
Practice Address - Street 1:101 VISION PARK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3011
Practice Address - Country:US
Practice Address - Phone:936-273-5214
Practice Address - Fax:936-273-5454
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2445207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN2445OtherMEDICAL LICENSE
TXN2445OtherMEDICAL LICENSE