Healthcare Provider Details

I. General information

NPI: 1508907353
Provider Name (Legal Business Name): DARRYL S COHEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16216 BAXTER RD 310
CHESTERFIELD MO
63017
US

IV. Provider business mailing address

16216 BAXTER RD 310
CHESTERFIELD MO
63017
US

V. Phone/Fax

Practice location:
  • Phone: 636-519-8899
  • Fax: 636-519-0011
Mailing address:
  • Phone: 636-519-8899
  • Fax: 636-519-0011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRIC34
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: