Provider Demographics
NPI:1275646937
Name:COHEN, GREGORY R (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:R
Last Name:COHEN
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 1:3020 N MILITARY TRL
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-1814
Mailing Address - Country:US
Mailing Address - Phone:561-981-8400
Mailing Address - Fax:561-981-9460
Practice Address - Street 1:3020 N MILITARY TRL
Practice Address - Street 2:SUITE 150
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-1814
Practice Address - Country:US
Practice Address - Phone:561-981-8400
Practice Address - Fax:561-981-9460
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46103207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD65283Medicare UPIN
FL61434Medicare ID - Type Unspecified