Individual
MARK COCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 N WESTHAVEN DR, OSHKOSH, WI 54904-6926
(902) 237-5000
Mailing address
3 NEENAH CTR, NEENAH, WI 54956-3070
(920) 237-5000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35075026
OH
207R00000X
Internal Medicine Physician
Primary
82456
WI
208000000X
Pediatrics Physician
35075026
OH
208000000X
Pediatrics Physician
82456
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2139760
—
OH
Enumeration date
12/05/2005
Last updated
08/08/2023
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