Provider Demographics
NPI:1881705523
Name:COCHRAN, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
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 1:18350 N MCLEOD WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-8863
Mailing Address - Country:US
Mailing Address - Phone:979-229-0729
Mailing Address - Fax:
Practice Address - Street 1:5950 UNIVERSITY AVE STE 341
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266
Practice Address - Country:US
Practice Address - Phone:515-875-9800
Practice Address - Fax:515-875-9804
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-12670208800000X
WAMD60515618208800000X
TXJ5291208800000X
IAMD-46379208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2039604Medicaid
ID1881705523OtherIPN
WA1881705523OtherFCHN
ID1881705523Medicaid
TX8G8737OtherBLUE CROSS
TX115421304Medicaid
WA1881705523OtherFCHN
WAG8936419Medicare PIN
ID20006188Medicare PIN
TXP00353794Medicare PIN
ID1881705523OtherIPN