Provider Demographics
NPI:1528300837
Name:COCKERELL DERMATOPATHOLOGY PA
Entity type:Organization
Organization Name:COCKERELL DERMATOPATHOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:J
Authorized Official - Last Name:COCKERELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-530-5200
Mailing Address - Street 1:2110 RESEARCH ROW
Mailing Address - Street 2:SUITE #100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-2519
Mailing Address - Country:US
Mailing Address - Phone:214-530-5200
Mailing Address - Fax:214-530-5230
Practice Address - Street 1:2110 RESEARCH ROW
Practice Address - Street 2:SUITE #100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-2519
Practice Address - Country:US
Practice Address - Phone:214-530-5200
Practice Address - Fax:214-530-5230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX289355Medicare PIN