Provider Demographics
NPI:1053355107
Name:COHEN, BRUCE HAGEDORN (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:HAGEDORN
Last Name:COHEN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4921 PARKVIEW PL
Mailing Address - Street 2:STE 14F
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1032
Mailing Address - Country:US
Mailing Address - Phone:314-361-5003
Mailing Address - Fax:314-361-2686
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:STE 14F
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-361-5003
Practice Address - Fax:314-361-2686
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2011-09-29
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Provider Licenses
StateLicense IDTaxonomies
MOR6B36207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA10464Medicare UPIN