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NPI Code Detail

MEDICARE: DR. TERRY WESLEY COCHRAN M.D.

MEDICARE: DR. TERRY WESLEY COCHRAN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician25577IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
227519OTHERIAWELLMARK PIN

General Provider Information

NPI Number : 1053326496
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TERRY WESLEY COCHRAN M.D.
Provider Business Mailing Address
First Line : 2000B SOUTH MAIN ST
Second Line : P.O. BOX 1507
City : FAIRFIELD
State : IA
Zip : 52556-3740
Country : US
Telephone Number : 641-472-4156
Fax Number : 641-472-9436
Provider Business Practice Location Address
First Line : 2000B SOUTH MAIN ST
Second Line :
City : FAIRFIELD
State : IA
Zip : 52556-3740
Country : US
Telephone Number : 641-472-4156
Fax Number : 641-472-9436
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 06/17/2009

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