Provider Demographics
NPI:1336177807
Name:COHEN, JUSTIN THOMAS (MD)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:THOMAS
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4875 WARD ROAD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033
Mailing Address - Country:US
Mailing Address - Phone:303-456-9456
Mailing Address - Fax:303-463-7560
Practice Address - Street 1:4875 WARD ROAD
Practice Address - Street 2:SUITE 600
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033
Practice Address - Country:US
Practice Address - Phone:303-456-9456
Practice Address - Fax:303-463-7560
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2010-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO35936207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01359363Medicaid
CO1359363Medicaid
CO01359363Medicaid
CO475138Medicare ID - Type Unspecified
COB68172Medicare UPIN