Healthcare Provider Details

I. General information

NPI: 1316253685
Provider Name (Legal Business Name): RICHARD HOWARD COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61243 GORGE VIEW ST
BEND OR
97702-3032
US

IV. Provider business mailing address

70 SW CENTURY DR STE 100-230
BEND OR
97702-3557
US

V. Phone/Fax

Practice location:
  • Phone: 805-724-6446
  • Fax:
Mailing address:
  • Phone: 805-724-6446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number18786
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD040712E
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: