Healthcare Provider Details

I. General information

NPI: 1568459915
Provider Name (Legal Business Name): TERRY B COHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEADOWS RD
BOCA RATON FL
33486-2304
US

IV. Provider business mailing address

PO BOX 862103
ORLANDO FL
32886-2103
US

V. Phone/Fax

Practice location:
  • Phone: 561-395-7100
  • Fax:
Mailing address:
  • Phone: 866-321-8433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberME0036467
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: