Provider Demographics
NPI:1184617193
Name:COHN, RICHARD ALAN (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:COHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 E CARONDELET DR
Mailing Address - Street 2:225
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2157
Mailing Address - Country:US
Mailing Address - Phone:520-886-9779
Mailing Address - Fax:520-546-4366
Practice Address - Street 1:6565 E CARONDELET DR
Practice Address - Street 2:225
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2157
Practice Address - Country:US
Practice Address - Phone:520-886-9779
Practice Address - Fax:520-546-4366
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2013-05-06
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
AZ10133174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ107366Medicare PIN
AZD43798Medicare UPIN
AZZ107365Medicare PIN