Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G89274 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | G89274 | CA |
N | 207ND0900X | Dermatopathologist | G89274 | CA |
NPI | 1366565467 |
---|---|
Provider Name | Philip R Cohen |
First Address | San Diego, CA 92131-3643 |
Second Address | National City, CA 91950-2978 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 11/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E19861 | (02) |