Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A5992 | CA |
Y | 207Q00000X | Family Doctor | 20A5992 | CA |
NPI | 1073599171 |
---|---|
Provider Name | Alan Cohn |
First Address | Mount Shasta, CA 96067-2796 |
Second Address | Mount Shasta, CA 96067-2796 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 26/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00AX59921 | (05) | CA |
F29055 | (02) | CA |