Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | 036-068229 | IL |
Y | 207RH0003X | Hematology & Oncology | 20100002678 | MO |
NPI | 1023015419 |
---|---|
Provider Name | Dr. Isaac I Cohen |
First Address | Washington, MO 63090-4700 |
Second Address | Washington, MO 63090-4700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 22/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036068229 | (05) | IL |
D16502 | (02) | IL |