MEDICARE: COCKERELL DERMATOPATHOLOGY PA

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	291U00000X	Clinical Medical Laboratory
2	207ZD0900X	Dermatopathology (Pathology) Physician

General Provider Information

NPI Number	:	1528300837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COCKERELL DERMATOPATHOLOGY PA

Provider Business Mailing Address
First Line	:	2110 RESEARCH ROW
Second Line	:	SUITE #100
City	:	DALLAS
State	:	TX
Zip	:	75235-2519
Country	:	US
Telephone Number	:	214-530-5200
Fax Number	:	214-530-5230

Provider Business Practice Location Address
First Line	:	2110 RESEARCH ROW
Second Line	:	SUITE #100
City	:	DALLAS
State	:	TX
Zip	:	75235-2519
Country	:	US
Telephone Number	:	214-530-5200
Fax Number	:	214-530-5230

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CLAY J COCKERELL
Credential	:	M.D.
Telephone Number	:	214-530-5200

Provider Enumeration Date	:	03/25/2013
Last Update Date	:	01/11/2024

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