Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 014907 | MO |
NPI | 1093737264 |
---|---|
Provider Name | Dr. William Cohen |
First Address | Saint Louis, MO 63141-8717 |
Second Address | Saint Louis, MO 63141-8717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |