Individual
JORDAN COHEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 86504-0649
(928) 729-8600
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504-0649
(928) 729-8000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
CMD16651
RI
207P00000X
Emergency Medicine Physician
LPO3292
RI
Other
Enumeration date
05/13/2015
Last updated
10/23/2019
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