MEDICARE: DR. CLAY J COCKERELL MD

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
1	207ND0900X	Dermatopathology Physician	F9311	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0019AY	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1235119298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLAY J COCKERELL MD

Provider Business Mailing Address
First Line	:	2110 RESEARCH ROW
Second Line	:	SUITE 100
City	:	DALLAS
State	:	TX
Zip	:	75235-2519
Country	:	US
Telephone Number	:	214-530-5200
Fax Number	:	214-530-5230

Provider Business Practice Location Address
First Line	:	2110 RESEARCH ROW
Second Line	:	SUITE 100
City	:	DALLAS
State	:	TX
Zip	:	75235-2519
Country	:	US
Telephone Number	:	214-530-5200
Fax Number	:	214-530-5230

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	05/20/2014

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