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General NPI Number Information
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NPI Number | 1598732372
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Entity Type | Individual
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Provider Name | MATTHEW I. K. COCKETT MD
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Gender | Male
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Dates
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Enumeration Date | 03/01/2006
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 921 W OWENS AVE STE 150
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City | LAS VEGAS
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State | NV
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Zip | 89106-5405
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Country | US
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Telephone | 725-269-3364
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Fax | 725-269-3366
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Provider Business Mailing Address
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Address Line | 102 WOODMONT BLVD STE 600
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City | NASHVILLE
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State | TN
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Zip | 37205-5250
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Country | US
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Telephone |
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Fax |
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | MD189897
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 28453
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License Number State | AZ
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