Provider Demographics
NPI:1053332536
Name:COHN, BRUCE JAY (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:JAY
Last Name:COHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-0229
Mailing Address - Country:US
Mailing Address - Phone:916-616-9268
Mailing Address - Fax:
Practice Address - Street 1:6500 COYLE AVE STE 2
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0301
Practice Address - Country:US
Practice Address - Phone:916-616-9268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46256207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G462560OtherBLUE SHIELD
CA00G462560OtherBLUE CROSS
CA00G462560OtherBLUE CROSS
00G462560Medicare PIN