Provider Demographics
NPI:1104087709
Name:COHEN, DAVID ALLEN (PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:COHEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 TALENT AVE
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-9638
Mailing Address - Country:US
Mailing Address - Phone:541-201-4900
Mailing Address - Fax:
Practice Address - Street 1:49 TALENT AVE
Practice Address - Street 2:
Practice Address - City:TALENT
Practice Address - State:OR
Practice Address - Zip Code:97540-9638
Practice Address - Country:US
Practice Address - Phone:541-201-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0680363A00000X
ORMD207470363A00000X
ORPA207470363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant