Provider Demographics
NPI:1295788008
Name:COHEN, JACK ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:ROBERT
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:909 N MIAMI BEACH BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3712
Mailing Address - Country:US
Mailing Address - Phone:305-949-2491
Mailing Address - Fax:305-949-1021
Practice Address - Street 1:909 N MIAMI BEACH BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3712
Practice Address - Country:US
Practice Address - Phone:305-949-2491
Practice Address - Fax:305-949-1021
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0030214207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0422800001OtherCIGNA
FL4311898OtherAETNA PPO
FL55060OtherJMH
FLP1528001OtherOXFORD
FL020463OtherNHP
FLS843801OtherCAREPLUS
DC18693OtherWELLCARE
FL2622370OtherAETNA
FL203994OtherAVMED
FL92846OtherBCBS FL
FLS843801OtherCAREPLUS
FLP1528001OtherOXFORD