Provider Demographics
NPI:1114946654
Name:COHEN, DEBORAH A (DPM)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:COHEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 NE 20TH TER
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4510
Mailing Address - Country:US
Mailing Address - Phone:954-202-9788
Mailing Address - Fax:954-491-2891
Practice Address - Street 1:4800 NE 20TH TER
Practice Address - Street 2:SUITE 107
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4510
Practice Address - Country:US
Practice Address - Phone:954-202-9788
Practice Address - Fax:954-491-2891
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0002042213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0566710001OtherDME
FL65249OtherBLUE CROSS BLUE SHEILD
FL390117300Medicaid
FL65249Medicare PIN
FL65249OtherBLUE CROSS BLUE SHEILD