1952320749 NPI number — DR. BRYAN COOK D.O.

Table of content: DR. BRYAN COOK D.O. (NPI 1952320749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952320749 NPI number — DR. BRYAN COOK D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOK
Provider First Name:
BRYAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952320749
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7066 STILLWATER BLVD N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKDALE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55128-3937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-777-5222
Provider Business Mailing Address Fax Number:
651-251-5111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7066 STILLWATER BLVD N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKDALE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55128-3937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-777-5222
Provider Business Practice Location Address Fax Number:
651-251-5111
Provider Enumeration Date:
07/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  432891 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1026868 . This is a "P1" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 368M2CO . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 247649 . This is a "CP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 32352 . This is a "HP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 143660 . This is a "UC" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 15-79521 . This is a "UBH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".