Individual
MR. JEDIDIAH PATRIOT COCHRAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1410 S GIN RD, ATOKA, OK 74525
(580) 889-3399
Mailing address
405 N LINDA AVE, ATOKA, OK 74525-1633
(580) 239-2988
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200287120A
—
OK
Enumeration date
01/18/2013
Last updated
01/18/2013
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