Provider Demographics
NPI:1124157391
Name:MCKEOWN, JOHN COCHRAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:COCHRAN
Last Name:MCKEOWN
Suffix:
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:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:TN
Mailing Address - Zip Code:37365-0100
Mailing Address - Country:US
Mailing Address - Phone:931-779-3691
Mailing Address - Fax:931-779-3690
Practice Address - Street 1:2578 MAIN ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:TN
Practice Address - Zip Code:37365-2730
Practice Address - Country:US
Practice Address - Phone:931-779-3691
Practice Address - Fax:931-779-3690
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD29059207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3811917Medicaid
TNP00386317OtherRAILROAD MEDICARE
TNP00386317OtherRAILROAD MEDICARE
TN3811917Medicare PIN