Individual provider · NPI-1

Larry L Cohen, MD

Family Medicine · Espanola, NM

NPI number1114011509
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1114011509
Entity type
Individual (NPI-1)
Name
Larry L Cohen
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
Oct 3, 2006
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine7311NMYes

Practice location

1010 Spruce St
Espanola Hospital
Espanola, NM 87532-2724

Phone 505-753-7111 · Fax 505-753-4438

Mailing address

Po Box 26666
Phs Provider Enrollment
Albuquerque, NM 87125-6666

Phone 505-923-5356 · Fax 505-923-5654

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