Provider Demographics
NPI:1265427587
Name:COHEN, HEZI (MD,)
Entity type:Individual
Prefix:DR
First Name:HEZI
Middle Name:
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 1:305 MEMORIAL MEDICAL PKW.
Mailing Address - Street 2:SUITE 208
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117
Mailing Address - Country:US
Mailing Address - Phone:386-231-3525
Mailing Address - Fax:386-231-3527
Practice Address - Street 1:305 MEMORIAL MEDICAL PKW.
Practice Address - Street 2:SUITE 208
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:386-231-3525
Practice Address - Fax:386-231-3527
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL080178811OtherRAILROAD MEDICARE
FL266878500Medicaid
FL58946ZMedicare ID - Type Unspecified
FL080178811OtherRAILROAD MEDICARE