Provider Demographics
NPI:1174610554
Name:COHEN, LEON (DPM)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:
Last Name:COHEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 W PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-4075
Mailing Address - Country:US
Mailing Address - Phone:575-885-3445
Mailing Address - Fax:575-887-0163
Practice Address - Street 1:1002 W PIERCE ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-4075
Practice Address - Country:US
Practice Address - Phone:575-885-3445
Practice Address - Fax:575-887-0163
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM047213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP00065233OtherRR MEDICARE
NM00053017Medicaid
NMNM015301OtherBCBS
NMNM015301OtherBCBS
NM5083500001Medicare NSC
NM344306002Medicare PIN