1588927628 NPI number — MARK D COOK, MD, INC

Table of content: (NPI 1588927628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588927628 NPI number — MARK D COOK, MD, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK D COOK, MD, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1588927628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1425 W H ST
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
OAKDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95361-3588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-848-1005
Provider Business Mailing Address Fax Number:
209-845-8918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1425 W H ST
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
OAKDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95361-3588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-848-1005
Provider Business Practice Location Address Fax Number:
209-845-8918
Provider Enumeration Date:
06/22/2012

Additional Information

Authorized Official

Authorized Official Last Name:
COOK
Authorized Official First Name:
MARK
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
209-848-1005

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2300X , with the licence number: A60965 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00A609650 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com