Basic Information
| Provider Information | |||||||||
| NPI: | 1073599171 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COHN | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 277 | ||||||||
| Address2: | |||||||||
| City: | BIEBER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960090277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5309999010 | ||||||||
| FaxNumber: | 5302945392 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 OLD MCCLOUD RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT SHASTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960672796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5309265100 | ||||||||
| FaxNumber: | 5309261859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2005 | ||||||||
| LastUpdateDate: | 08/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204D00000X | 20A5992 | CA | N | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM | 207Q00000X | 20A5992 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00AX59921 | 05 | CA | MEDICAID |