Provider Demographics
NPI:1629047956
Name:COHEN, GREGORY LEE (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:LEE
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2858 N BELT LINE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-9382
Mailing Address - Country:US
Mailing Address - Phone:972-285-8966
Mailing Address - Fax:972-285-8966
Practice Address - Street 1:3610 SHIRE BLVD STE 208
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2239
Practice Address - Country:US
Practice Address - Phone:214-983-2020
Practice Address - Fax:972-769-5740
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24403207W00000X
NV8928207W00000X
TXU1653207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2016721Medicaid
31700Medicare ID - Type Unspecified
NV2016721Medicaid