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General NPI Number Information
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NPI Number | 1053452128
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Entity Type | Individual
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Provider Name | GARY WILLIAM COCKRELL D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 785 OLD HICKORY BLVD SUITE 101
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City | BRENTWOOD
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State | TN
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Zip | 37027-4512
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Country | US
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Telephone | 615-370-8880
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Fax | 615-370-9039
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Provider Business Mailing Address
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Address Line | 785 OLD HICKORY BLVD SUITE 101
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City | BRENTWOOD
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State | TN
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Zip | 37027-4512
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Country | US
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Telephone | 615-370-8880
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Fax | 615-370-9039
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | DPM0000000353
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | DPM0000000353
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License Number State | TN
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