Healthcare Provider Details

I. General information

NPI: 1932119930
Provider Name (Legal Business Name): JOSEPH I COHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BUTTERCUP CREEK BLVD SUITE # 100
CEDAR PARK TX
78613-3708
US

IV. Provider business mailing address

200 BUTTERCUP CREEK BLVD SUITE # 100
CEDAR PARK TX
78613-3708
US

V. Phone/Fax

Practice location:
  • Phone: 512-335-9600
  • Fax: 512-335-9696
Mailing address:
  • Phone: 512-335-9600
  • Fax: 512-335-9696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL7537
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: