Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 024904 | LA |
NPI | 1427026996 |
---|---|
Provider Name | Dr. Thomas Patrick Cockerham |
First Address | Baton Rouge, LA 70809 |
Second Address | Baton Rouge, LA 70809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 08/07/2007 |