Provider Demographics
NPI:1073599171
Name:COHN, ALAN (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
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 277
Mailing Address - Street 2:
Mailing Address - City:BIEBER
Mailing Address - State:CA
Mailing Address - Zip Code:96009-0277
Mailing Address - Country:US
Mailing Address - Phone:530-999-9010
Mailing Address - Fax:530-294-5392
Practice Address - Street 1:101 OLD MCCLOUD RD
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2796
Practice Address - Country:US
Practice Address - Phone:530-926-5100
Practice Address - Fax:530-926-1859
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5992204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX59921Medicaid
CA990014897Medicare PIN
CA00AX59921Medicaid
CA020A59921Medicare PIN