Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 125 | NM |
Y | 222Z00000X | Podiatrist | 125 | NM |
N | 213E00000X | Podiatrist | 553 | TX |
N | 222Z00000X | Podiatrist | 553 | TX |
NPI | 1033204854 |
---|---|
Provider Name | Michael D Cohen |
First Address | Hobbs, NM 88240-5128 |
Second Address | Hobbs, NM 88240-5128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 05/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
52233 | (05) | NM |
NM005329 | BC-BS (01) | NM |
U04009 | (02) |