Healthcare Provider Details

I. General information

NPI: 1629051255
Provider Name (Legal Business Name): MARY E COCHRAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 N KIBLER PL STE. 1
TUCSON AZ
85712-2100
US

IV. Provider business mailing address

PO BOX 43100
TUCSON AZ
85733-3100
US

V. Phone/Fax

Practice location:
  • Phone: 520-648-5437
  • Fax:
Mailing address:
  • Phone: 520-648-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14651
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5324
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: