Basic Information
| Provider Information | |||||||||
| NPI: | 1982696753 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COHAN | ||||||||
| FirstName: | STUART | ||||||||
| MiddleName: | K. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5430 RUTHERGLENN DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770964032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137210146 | ||||||||
| FaxNumber: | 7137210146 | ||||||||
| Practice Location | |||||||||
| Address1: | 6421 FANNIN ST | ||||||||
| Address2: | MSB 3-142 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135005666 | ||||||||
| FaxNumber: | 7135000527 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 04/20/2011 | ||||||||
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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 | 204C00000X | C- 4776 | TX | Y | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine, Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | PO81450B6 | 05 | TX | MEDICAID |