Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | C- 4776 | TX |
NPI | 1982696753 |
---|---|
Provider Name | Dr. Stuart K. Cohan |
First Address | Houston, TX 77096-4032 |
Second Address | Houston, TX 77030-1501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 20/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G35775 | (02) | TX |
PO81450B6 | (05) | TX |