Healthcare Provider Details

I. General information

NPI: 1134361603
Provider Name (Legal Business Name): SHAWN WAYNE COCHRANE M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11083 COLORADO BLVD
FIRESTONE CO
80504-5873
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 303-833-8880
  • Fax: 303-682-8007
Mailing address:
  • Phone: 970-624-2409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0050738
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: