Provider Demographics
NPI:1639171986
Name:COHEN, ROSS A (MD)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:A
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:5065 STATE ROAD 17
Practice Address - Street 2:SUITE 203
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33449-4615
Practice Address - Country:US
Practice Address - Phone:561-432-0067
Practice Address - Fax:561-432-0066
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056876208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL206497OtherAVMED
FL3431OtherDIMENSION
FL09628OtherBC/BS FLORIDA
FL340003666OtherRR MEDICARE
FL1193668OtherCIGNA
FLP971746OtherOPTIMUM
FLP00337OtherFREEDOM
FL09628OtherBCBS
FL340003666Medicaid
FL4116931OtherAETNA
FLP01604779OtherRR MEDICARE
FL06798OtherWELLCARE
FL1010101OtherWELLCARE
FLP01604779OtherRR MEDICARE
FL1010101OtherWELLCARE
FL206497OtherAVMED