Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 020A42310 | CA |
N | 207Q00000X | Family Doctor | 020A42310 | CA |
NPI | 1659332229 |
---|---|
Provider Name | Dr. Elwood Cohen |
First Address | Lake Arrowhead, CA 92352-2884 |
Second Address | Lake Arrowhead, CA 92352-2884 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C64493 | (02) | CA |