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General NPI Number Information
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NPI Number | 1831376508
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Entity Type | Organization
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Legal Business Name | COHEN PODIATRY CLINICS
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Dates
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Enumeration Date | 01/24/2008
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 12056 MOBILE AVE
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City | GULFPORT
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State | MS
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Zip | 39503-3004
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Country | US
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Telephone | 228-832-4475
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Fax | 228-832-1512
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Provider Business Mailing Address
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Address Line | 12056 MOBILE AVE
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City | GULFPORT
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State | MS
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Zip | 39503-3004
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Country | US
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Telephone | 228-832-4475
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Fax | 228-832-1512
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. EDWARD ROBERT COHEN
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Credential | D.P.M.
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Telephone | 228-832-4475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | 80055
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License Number State | MS
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