MEDICARE: GREGORY GERARD COOK D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0131X	Foot Surgery Podiatrist	PO0002468	FL

General Provider Information

NPI Number	:	1174711204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY GERARD COOK D.P.M.

Provider Business Mailing Address
First Line	:	4040 UPPER CREEK DR STE 106
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6844
Country	:	US
Telephone Number	:	727-824-5100
Fax Number	:	727-824-5132

Provider Business Practice Location Address
First Line	:	4040 UPPER CREEK DR STE 106
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-6844
Country	:	US
Telephone Number	:	813-645-1993
Fax Number	:	727-824-5132

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	07/20/2021

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