1700867199 NPI number — JOSEPH A COOK MD

Table of content: JOSEPH A COOK MD (NPI 1700867199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700867199 NPI number — JOSEPH A COOK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOK
Provider First Name:
JOSEPH
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1700867199
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3551 ROGER BROOKE DR
Provider Second Line Business Mailing Address:
GASTROENTEROLOGY DEPARTMENT, C/O LTCOL JOSEPH A COOK
Provider Business Mailing Address City Name:
FORT SAM HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78234-4504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-916-3647
Provider Business Mailing Address Fax Number:
210-916-3195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6259 W EMERALD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83704-8731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-489-1900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/11/2005

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: 207RG0100X , with the licence number:  0101057898 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: M15050 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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