Provider Demographics
NPI:1912957317
Name:COHEN, BRUCE S (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:S
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 1:8100 ROYAL PALM BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5733
Mailing Address - Country:US
Mailing Address - Phone:954-752-1999
Mailing Address - Fax:954-752-8756
Practice Address - Street 1:8100 ROYAL PALM BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5733
Practice Address - Country:US
Practice Address - Phone:954-752-1999
Practice Address - Fax:954-752-8756
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-1178213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041207401Medicaid
FL87681AMedicare ID - Type UnspecifiedPROVIDER NUMBER
FLT55499Medicare UPIN