Provider Demographics
NPI:1770671323
Name:COHEN, DOUGLAS H (DPM)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:H
Last Name:COHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 S OCEAN BLVD
Mailing Address - Street 2:SUITE 12G
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-8535
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8614 E STATE ROAD 70
Practice Address - Street 2:SUITE 200
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-3710
Practice Address - Country:US
Practice Address - Phone:941-408-5517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2667213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL480033658OtherRR MEDICARE
FL340218500Medicaid
FL629392OtherANTHEM BCBS
FL149485OtherUMWA
FL629392OtherANTHEM BCBS
FLU66346Medicare UPIN