=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528398450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COHEN FAMILY MEDICINE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/25/2009
-----------------------------------------------------
Last Update Date | 09/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2830 N SWAN RD SUITE 180
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85712-6306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-881-1805
-----------------------------------------------------
Fax | 520-881-1842
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5391 N CAMINO SUMO
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85718-5133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-909-8802
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. STEPHEN ANDREW COHEN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 520-909-8802
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------