Provider Demographics
NPI:1285686774
Name:COHEN, NATHAN PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:PHILLIP
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:PO BOX 122165 DEPT 2165
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-0001
Mailing Address - Country:US
Mailing Address - Phone:337-494-2772
Mailing Address - Fax:337-494-2928
Practice Address - Street 1:1717 OAK PARK BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8991
Practice Address - Country:US
Practice Address - Phone:337-494-4900
Practice Address - Fax:337-494-4797
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05658R207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1326127Medicaid
LA05658ROtherSTATE LICENSE NO.
LAP00451334OtherRAILROAD MCR
LA1326127Medicaid
LA$$$$$$$$$BOtherBCBS
LA05658ROtherSTATE LICENSE NO.
LA51684BC61Medicare PIN
LA51684Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NO.