# WILEY T. COCKRELL JR.

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1821191149
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | 38915 | NC | — |
| 207Q00000X | Family Medicine Physician | 38915 | NC | Yes |

## Other

- **Enumeration date:** 09/06/2006
- **Last updated:** 11/20/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 23204 | BCBS PROVIDER NUMBER | NC |
| 05 | — | 8923204 | — | NC |