MEDICARE: JULIE COOK PA.C.

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	363A00000X	Physician Assistant	PA04477	TX

General Provider Information

NPI Number	:	1467437145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE COOK PA.C.

Provider Business Mailing Address
First Line	:	2223 DORRINGTON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-3209
Country	:	US
Telephone Number	:	713-665-0404
Fax Number	:	713-665-4007

Provider Business Practice Location Address
First Line	:	2223 DORRINGTON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-3209
Country	:	US
Telephone Number	:	713-665-0404
Fax Number	:	713-665-4007

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	07/08/2007

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