Provider Demographics
NPI:1336174150
Name:COHN, JEROME A (DPM)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:A
Last Name:COHN
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:PO BOX 25919
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85285-5919
Mailing Address - Country:US
Mailing Address - Phone:480-967-6500
Mailing Address - Fax:480-967-6540
Practice Address - Street 1:13555 W MCDOWELL RD
Practice Address - Street 2:SUITE 301
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2629
Practice Address - Country:US
Practice Address - Phone:623-848-0123
Practice Address - Fax:623-848-1173
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ302213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ700965Medicaid
AZP4880008873OtherMEDICARE RR
AZ700965Medicaid
AZZ115610Medicare PIN