Basic Information
| Provider Information | |||||||||
| NPI: | 1063485886 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COHEN | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 846098 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752846098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033246450 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1327 TROUP HWY | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757014443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035108764 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 04/01/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | J7933 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207RR0500X | J7933 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 117681002 | 05 | TX | MEDICAID | 4110112 | 01 | TX | AETNA | OTHER | CO083Y726 | 01 | TX | BCBS | OTHER | 752616977061 | 01 | TX | TRICARE CHAMPUS | OTHER | 117681004 | 05 | TX | MEDICAID | 83Y726 | 01 | TX | BCBS OF TEXAS | OTHER | 110115677 | 01 | TX | MEDICARE RAILROAD | OTHER | 123033 | 01 | TX | CHIPS | OTHER |