Healthcare Provider Details

I. General information

NPI: 1447295209
Provider Name (Legal Business Name): ROBERT C COCKRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17100 EUCLID
FOUNTAIN VALLEY CA
92708
US

IV. Provider business mailing address

PO BOX 20140
FOUNTAIN VALLEY CA
92728-0140
US

V. Phone/Fax

Practice location:
  • Phone: 714-966-7200
  • Fax:
Mailing address:
  • Phone: 562-809-3572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG26974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: