Healthcare Provider Details

I. General information

NPI: 1427548767
Provider Name (Legal Business Name): NATHAN JAMES COCKERILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2018
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E ROOSEVELT ST
PHOENIX AZ
85008-4973
US

IV. Provider business mailing address

5151 N 16TH ST APT 2050
PHOENIX AZ
85016-3811
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-5762
  • Fax:
Mailing address:
  • Phone: 574-276-8729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number77387
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number77387
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: