Provider Demographics
NPI:1104825488
Name:COHN, EVAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:L
Last Name:COHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:816 W CANNON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3146
Mailing Address - Country:US
Mailing Address - Phone:214-363-8378
Mailing Address - Fax:214-363-0720
Practice Address - Street 1:815 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 710
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2224
Practice Address - Country:US
Practice Address - Phone:817-321-0387
Practice Address - Fax:214-363-0720
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK50842085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102972003Medicaid
TX102972002Medicaid
TX102972003Medicaid
TX82714RMedicare ID - Type UnspecifiedDALLAS COUNTY
TXG45513Medicare UPIN