Healthcare Provider Details

I. General information

NPI: 1528300837
Provider Name (Legal Business Name): COCKERELL DERMATOPATHOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 RESEARCH ROW SUITE #100
DALLAS TX
75235-2519
US

IV. Provider business mailing address

2110 RESEARCH ROW SUITE #100
DALLAS TX
75235-2519
US

V. Phone/Fax

Practice location:
  • Phone: 214-530-5200
  • Fax: 214-530-5230
Mailing address:
  • Phone: 214-530-5200
  • Fax: 214-530-5230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CLAY J COCKERELL
Title or Position: OWNER
Credential: M.D.
Phone: 214-530-5200