Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 6251 | IA |
NPI | 1144309725 |
---|---|
Provider Name | Dr. Robert Bruce Cochrane |
First Address | Fort Dodge, IA 50501 |
Second Address | Fort Dodge, IA 50501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0143495 | (05) | IA |