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General NPI Number Information
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NPI Number | 1245262690
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Entity Type | Organization
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Legal Business Name | LARRY L COHEN MD, PC
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9 CALLE DE VALLE
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City | SANTA FE
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State | NM
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Zip | 87505-6318
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Country | US
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Telephone | 505-983-3997
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Fax |
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Provider Business Mailing Address
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Address Line | 9 CALLE DE VALLE
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City | SANTA FE
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State | NM
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Zip | 87505-6318
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LARRY COHEN
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Credential | M.D.
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Telephone | 505-983-3997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 73-11
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License Number State | NM
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