Healthcare Provider Details

I. General information

NPI: 1407114507
Provider Name (Legal Business Name): BURTON HARRY COHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 08/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 FOUNTAIN RUN
NAPLES FL
34119-1355
US

IV. Provider business mailing address

990 FOUNTAIN RUN
NAPLES FL
34119-1355
US

V. Phone/Fax

Practice location:
  • Phone: 239-455-9527
  • Fax:
Mailing address:
  • Phone: 239-455-9527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD014575E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: