MEDICARE: CLAY TRAVIS COHEN 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	390200000X	Student in an Organized Health Care Education/Training Program
2	2080P0207X	Pediatric Hematology & Oncology Physician	R5989	TX
3	208000000X	Pediatrics Physician	R5989	TX

General Provider Information

NPI Number	:	1902196397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAY TRAVIS COHEN M.D.

Provider Business Mailing Address
First Line	:	1102 BATES AVE STE 1570.10
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2617
Country	:	US
Telephone Number	:	832-824-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6701 FANNIN ST STE 1400
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2613
Country	:	US
Telephone Number	:	832-824-4242
Fax Number	:

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

Provider Enumeration Date	:	04/19/2011
Last Update Date	:	10/26/2022

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