Provider Demographics
NPI:1437113727
Name:COHEN, TERRI R (DPM)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:R
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 1:424 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-664-8888
Mailing Address - Fax:501-664-3106
Practice Address - Street 1:424 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-664-8888
Practice Address - Fax:501-664-3106
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR105213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR112328717Medicaid
AR480022176OtherRAILROAD MEDICARE
14172000010OtherQUAL CHOICE OF ARKANSAS
57449Medicare ID - Type Unspecified
AR59104Medicare PIN
T20569Medicare UPIN
AR59104Medicare ID - Type Unspecified