Healthcare Provider Details

I. General information

NPI: 1275533754
Provider Name (Legal Business Name): RICHARD COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 NW 6TH ST
GRANTS PASS OR
97526-1094
US

IV. Provider business mailing address

1600 NW 6TH ST
GRANTS PASS OR
97526-1094
US

V. Phone/Fax

Practice location:
  • Phone: 541-476-7775
  • Fax: 541-476-3572
Mailing address:
  • Phone: 541-476-7775
  • Fax: 541-476-3572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD10466
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: