Provider Demographics
NPI:1417910845
Name:COHEN, BRENDA K (DPM)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
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 1:7200 WYOMING SPGS STE 1150
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4310
Mailing Address - Country:US
Mailing Address - Phone:512-255-0125
Mailing Address - Fax:512-255-0153
Practice Address - Street 1:7200 WYOMING SPGS STE 1150
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4310
Practice Address - Country:US
Practice Address - Phone:512-255-0125
Practice Address - Fax:512-255-0153
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1405213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100435002Medicaid
TX80750XOtherBCBS
TX100435002Medicaid
TX80041NMedicare PIN