Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | G9436 | CA |
NPI | 1558479105 |
---|---|
Provider Name | Dr. Robert Cohen |
First Address | Novato, CA 94947 |
Second Address | Greenbrae, CA 94904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000G94360 | (05) | CA |
A58904 | (02) |