Individual
EDWARD ROBERT COHEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
12056 MOBILE AVE, GULFPORT, MS 39503-3113
(228) 832-4475
(228) 832-1512
Mailing address
12056 MOBILE AVE, GULFPORT, MS 39503-3004
(228) 832-4475
(228) 832-1512
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
640616729
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00016981
—
MS
01
—
2730008
UHC
MS
01
—
409879
WINDSOR MEDICARE EXTRA
MS
Enumeration date
06/30/2005
Last updated
07/11/2012
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