MEDICARE: DR. PETER D. COHN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	E9584	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	751565302	OTHER	TX	TAX ID #

General Provider Information

NPI Number	:	1013941442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER D. COHN M.D.

Provider Business Mailing Address
First Line	:	6330 LBJ FWY
Second Line	:	235
City	:	DALLAS
State	:	TX
Zip	:	75240-6467
Country	:	US
Telephone Number	:	214-750-6711
Fax Number	:	214-594-9014

Provider Business Practice Location Address
First Line	:	6330 LBJ FWY
Second Line	:	235
City	:	DALLAS
State	:	TX
Zip	:	75240-6467
Country	:	US
Telephone Number	:	214-750-6711
Fax Number	:	214-594-9014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/19/2016

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