Healthcare Provider Details

I. General information

NPI: 1528195252
Provider Name (Legal Business Name): DANIEL CLAY COCHRAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 24TH AVE SW
NORMAN OK
73069-3913
US

IV. Provider business mailing address

1122 NE 13TH ST ORI 274B
OKLAHOMA CITY OK
73117-1039
US

V. Phone/Fax

Practice location:
  • Phone: 405-325-5800
  • Fax:
Mailing address:
  • Phone: 405-271-1515
  • Fax: 405-271-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number29115
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: