Provider Demographics
NPI:1669867099
Name:COCKERELL, JOHN ALLEN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALLEN
Last Name:COCKERELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:A
Other - Last Name:COCKERELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4020 RICHARDS RD STE I
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2744
Mailing Address - Country:US
Mailing Address - Phone:501-917-9693
Mailing Address - Fax:501-916-9804
Practice Address - Street 1:4020 RICHARDS RD STE I
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2744
Practice Address - Country:US
Practice Address - Phone:501-916-9693
Practice Address - Fax:501-916-9804
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-11342207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ART1AR5058Medicaid
AR22848801Medicaid