MEDICARE: GLENDON E COOK 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	207Q00000X	Family Medicine Physician	MD223655	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000266485	OTHER	PA	UNISON
2	824355	OTHER	PA	FPH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000063294	OTHER	PA	BLUESHIELD

General Provider Information

NPI Number	:	1952343816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENDON E COOK M.D.

Provider Business Mailing Address
First Line	:	1701 NW HAWTHORNE AVE
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1051
Country	:	US
Telephone Number	:	541-472-4777
Fax Number	:	541-471-1439

Provider Business Practice Location Address
First Line	:	1701 NW HAWTHORNE AVE
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-1051
Country	:	US
Telephone Number	:	541-472-4777
Fax Number	:	541-471-1439

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	04/07/2025

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Directions to “ GLENDON E COOK M.D.” Practice Location

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