Individual
CLAYTON DALE COCKRELL II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
2131 MILITARY ST S, HAMILTON, AL 35570
(205) 921-5556
(205) 921-5595
Mailing address
2131 MILITARY ST S, HAMILTON, AL 35570-6651
(205) 921-5556
(205) 921-5595
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1-099596
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
515-35921
BLUE CROSS PROVIDER ##
AL
05
—
891012300
—
AL
Enumeration date
08/30/2006
Last updated
04/11/2011
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