Provider Demographics
NPI:1053347823
Name:COCKRELL, WAYNE POE JR (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:POE
Last Name:COCKRELL
Suffix:JR
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 1:3610 SPRINGHILL MEMORIAL DR. N.
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608
Mailing Address - Country:US
Mailing Address - Phone:251-410-3600
Mailing Address - Fax:251-410-3700
Practice Address - Street 1:3610 SPRINGHILL MEMORIAL DR N
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1162
Practice Address - Country:US
Practice Address - Phone:251-410-3600
Practice Address - Fax:251-410-3700
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00011069208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126118Medicaid
AL102I058171Medicare PIN
C-71380Medicare UPIN
MS05-000597Medicare ID - Type Unspecified