Provider Demographics
NPI:1235119736
Name:COHEN, GREG D (DO)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:D
Last Name:COHEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARITON
Mailing Address - State:IA
Mailing Address - Zip Code:50049-1210
Mailing Address - Country:US
Mailing Address - Phone:641-774-8103
Mailing Address - Fax:641-774-8087
Practice Address - Street 1:1200 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CHARITON
Practice Address - State:IA
Practice Address - Zip Code:50049-1210
Practice Address - Country:US
Practice Address - Phone:641-774-8103
Practice Address - Fax:641-774-8087
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02839207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3109223Medicaid
IA40874OtherBCBS
IA1235119736OtherWELLMARK
IA40873OtherBCBS
IA1235119736Medicaid
IA40873OtherBCBS
IAF72820Medicare UPIN
IA1235119736OtherWELLMARK
IA40874OtherBCBS
IA40873Medicare ID - Type Unspecified
IA1235119736Medicaid