Provider Demographics
NPI:1689606634
Name:COHEN, PHILLIP E (DO PA)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:E
Last Name:COHEN
Suffix:
Gender:M
Credentials:DO PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W CANNON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3029
Mailing Address - Country:US
Mailing Address - Phone:817-877-5858
Mailing Address - Fax:817-335-4418
Practice Address - Street 1:909 9TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3932
Practice Address - Country:US
Practice Address - Phone:817-725-7880
Practice Address - Fax:817-447-7110
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2603207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099442802Medicaid
D97281Medicare UPIN
TX099442802Medicaid