Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | 9700037 | AZ |
NPI | 1467457267 |
---|---|
Provider Name | Jill A Cohen |
First Address | Tucson, AZ 85715-3477 |
Second Address | Tucson, AZ 85715-3477 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 30/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
429573 | (05) | AZ |
AZ0875000 | BCBS/AZ (01) | AZ |
G71059 | (02) | AZ |