MEDICARE: RONALD JAY COCHRAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	F1461	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407899875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD JAY COCHRAN MD

Provider Business Mailing Address
First Line	:	1918 WEST LOOP
Second Line	:
City	:	EL CAMPO
State	:	TX
Zip	:	77437
Country	:	US
Telephone Number	:	979-543-1800
Fax Number	:	979-543-5931

Provider Business Practice Location Address
First Line	:	1918 WEST LOOP
Second Line	:
City	:	EL CAMPO
State	:	TX
Zip	:	77437
Country	:	US
Telephone Number	:	979-543-1800
Fax Number	:	979-543-5931

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	07/12/2010

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