MEDICARE: LARRY KENNETH COHEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	ME87633	FL

General Provider Information

NPI Number	:	1780684787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY KENNETH COHEN MD

Provider Business Mailing Address
First Line	:	470 COLUMBIA DR
Second Line	:	SUITE A102
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-1997
Country	:	US
Telephone Number	:	561-640-4000
Fax Number	:	561-640-8098

Provider Business Practice Location Address
First Line	:	470 COLUMBIA DR
Second Line	:	SUITE A102
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-1997
Country	:	US
Telephone Number	:	561-640-4000
Fax Number	:	561-640-8098

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	05/18/2009

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