Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 042-0014399 | VT |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 24699 | MS |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 32997 | MT |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 45230 | KY |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 67287 | GA |
NPI | 1013996586 |
---|---|
Provider Name | Dr. Richard P Cochran |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39216-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 19/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09954520 | (05) | MS |
62993301 | (05) | HI |
C14569 | (02) | ME |