Healthcare Provider Details

I. General information

NPI: 1407869712
Provider Name (Legal Business Name): EVELYN COHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 WESR HIGHWAY 98
PENSACOLA FL
32512-0008
US

IV. Provider business mailing address

972 CANDLESTICK CT
PENSACOLA FL
32514-1549
US

V. Phone/Fax

Practice location:
  • Phone: 850-505-6463
  • Fax: 850-505-6527
Mailing address:
  • Phone: 850-505-6463
  • Fax: 850-477-3296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number4311
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: