=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003085937
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WM MICHAEL COCHRAN MD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2008
-----------------------------------------------------
Last Update Date | 04/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 140 W DUVAL MINE RD SUITE 106
-----------------------------------------------------
City | GREEN VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85614-5000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-989-3521
-----------------------------------------------------
Fax | 520-989-3522
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4050 N CIRCULO MANZANILLO
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85750-1879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-989-3521
-----------------------------------------------------
Fax | 520-989-3522
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RN, OFFICE MANAGER
-----------------------------------------------------
Name | BETH COCHRAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 520-989-3521
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | AZ15469
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------