Healthcare Provider Details

I. General information

NPI: 1154319879
Provider Name (Legal Business Name): THOMAS SAMUEL COCHRAN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 E ELIZABETH ST SUITE 1
FORT COLLINS CO
80524-4000
US

IV. Provider business mailing address

1236 E ELIZABETH ST SUITE 1
FORT COLLINS CO
80524-4000
US

V. Phone/Fax

Practice location:
  • Phone: 970-224-2985
  • Fax: 970-472-9381
Mailing address:
  • Phone: 970-224-2985
  • Fax: 970-472-9381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number26013
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: