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NPI Code Detail

MEDICARE: JOHNLCOCCHIARAMDAPROFESSIONALMEDICALCORPORATION

MEDICARE: JOHNLCOCCHIARAMDAPROFESSIONALMEDICALCORPORATION
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
1208600000XSurgery Physician

General Provider Information

NPI Number : 1871806935
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOHNLCOCCHIARAMDAPROFESSIONALMEDICALCORPORATION
Provider Business Mailing Address
First Line : 1739 RYAN ST
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70601-6049
Country : US
Telephone Number : 337-439-9419
Fax Number : 337-491-9577
Provider Business Practice Location Address
First Line : 1739 RYAN ST
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70601-6049
Country : US
Telephone Number : 337-439-9419
Fax Number : 337-491-9577
Authorized Official
Title or Position : GENERAL SURGEON
Name : JOHN LUCAS COCCHIARA
Credential : M.D.
Telephone Number : 337-439-9419
Provider Enumeration Date : 07/19/2010
Last Update Date : 10/15/2010

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