Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 1001163 | WI |
N | 1223G0001X | General Practice | 1001163 | WI |
N | 213EG0000X | General Practice | 1001163 | WI |
NPI | 1003299355 |
---|---|
Provider Name | Dr. Gregory Cochrane |
First Address | La Crosse, WI 54601-6964 |
Second Address | La Crosse, WI 54601-6964 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2015 |
Last Update Date | 12/05/2021 |