MEDICARE: DR. LAWRENCE WILLIAM COOKE M.D.

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	208D00000X	General Practice Physician	G71266	CA

General Provider Information

NPI Number	:	1578690475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE WILLIAM COOKE M.D.

Provider Business Mailing Address
First Line	:	23521 PASEO DE VALENCIA
Second Line	:	SUITE B2
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3107
Country	:	US
Telephone Number	:	949-215-1511
Fax Number	:	949-215-1512

Provider Business Practice Location Address
First Line	:	24331 EL TORO RD STE 330
Second Line	:
City	:	LAGUNA WOODS
State	:	CA
Zip	:	92637-2754
Country	:	US
Telephone Number	:	949-215-1511
Fax Number	:	949-215-1512

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	05/20/2011

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