Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | DPM0000000353 | TN |
N | 222Z00000X | Podiatrist | DPM0000000353 | TN |
Y | 213ES0131X | Foot Surgery | DPM0000000353 | TN |
NPI | 1053452128 |
---|---|
Provider Name | Gary William Cockrell |
First Address | Brentwood, TN 37027-4512 |
Second Address | Brentwood, TN 37027-4512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 04/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
621451791 | FEDERAL EMPLOYER TAX ID # (01) | TN |
T82562 | (02) | TN |