Provider Demographics
NPI:1952425266
Name:COHEN, LARRY JOE (DPM)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:JOE
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 1:12333 WETMORE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-3638
Mailing Address - Country:US
Mailing Address - Phone:210-495-6477
Mailing Address - Fax:210-495-6484
Practice Address - Street 1:12333 WETMORE RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-3638
Practice Address - Country:US
Practice Address - Phone:210-495-6477
Practice Address - Fax:210-495-6484
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX475213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist