Individual
LARRY L COHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1010 SPRUCE ST, ESPANOLA HOSPITAL, ESPANOLA, NM 87532-2724
(505) 753-7111
(505) 753-4438
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-5356
(505) 923-5654
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
7311
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17665
—
NM
Enumeration date
10/03/2006
Last updated
07/08/2007
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