Provider Demographics
NPI:1558329607
Name:COHEN, LEON A (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:A
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:375 S COURTENAY PKWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4886
Mailing Address - Country:US
Mailing Address - Phone:321-453-3420
Mailing Address - Fax:321-453-8262
Practice Address - Street 1:375 S COURTENAY PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4886
Practice Address - Country:US
Practice Address - Phone:321-453-3420
Practice Address - Fax:321-453-8262
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME50207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046926200Medicaid
FL046926200Medicaid
FL04582ZMedicare PIN
FLD84797Medicare UPIN