Healthcare Provider Details

I. General information

NPI: 1225077464
Provider Name (Legal Business Name): LESLIE ANN COHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 HIGHLAND BLVD
BOZEMAN MT
59715-6902
US

IV. Provider business mailing address

915 HIGHLAND BLVD
BOZEMAN MT
59715-6902
US

V. Phone/Fax

Practice location:
  • Phone: 406-585-1000
  • Fax:
Mailing address:
  • Phone: 406-585-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number34334
License Number StateMT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8396715
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 2
Identifier0185620
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerLIWA
# 3
Identifier2166CO
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerBSWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: