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General NPI Number Information
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NPI Number | 1700946076
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Entity Type | Individual
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Provider Name | GILBERT ORVILLE COCHRAN ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 12/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 400 HOSPITAL RD
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City | STARKVILLE
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State | MS
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Zip | 39759-2163
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Country | US
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Telephone | 662-615-3023
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Fax | 662-615-3021
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Provider Business Mailing Address
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Address Line | 120 LOGAN DR # B
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City | STARKVILLE
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State | MS
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Zip | 39759-4414
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Country | US
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Telephone | 662-615-1501
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT0406
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License Number State | MS
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