Provider Demographics
NPI:1629163308
Name:COHEN, HARRY B (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:B
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 773
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-0773
Mailing Address - Country:US
Mailing Address - Phone:307-578-1871
Mailing Address - Fax:307-587-2364
Practice Address - Street 1:726 ALLEN AVE STE B
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3442
Practice Address - Country:US
Practice Address - Phone:307-578-1860
Practice Address - Fax:307-587-2364
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6726A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYA13521Medicare UPIN
WY20187Medicare ID - Type Unspecified