Provider Demographics
NPI:1861432296
Name:COCHRAN, MORRIS WAYNE (MD)
Entity type:Individual
Prefix:
First Name:MORRIS
Middle Name:WAYNE
Last Name:COCHRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5551 US HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459
Mailing Address - Country:US
Mailing Address - Phone:850-420-5420
Mailing Address - Fax:850-244-8011
Practice Address - Street 1:5551 US HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459
Practice Address - Country:US
Practice Address - Phone:850-420-5420
Practice Address - Fax:850-244-8011
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14439207Q00000X
FLME137492207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1861432296Medicaid