=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104882240
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD L COHEN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2006
-----------------------------------------------------
Last Update Date | 03/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13590 S JOG RD STE 2
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33446-3807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-381-7773
-----------------------------------------------------
Fax | 561-381-7774
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13590 S JOG RD STE 2
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33446-3807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-726-6868
-----------------------------------------------------
Fax | 954-726-8818
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | ME24014
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------