Healthcare Provider Details

I. General information

NPI: 1487195954
Provider Name (Legal Business Name): MEGAN COOK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN MCDOUGALL

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 ZEAMER AVE
JBER AK
99506-3702
US

IV. Provider business mailing address

5955 ZEAMER AVE
JBER AK
99506-3702
US

V. Phone/Fax

Practice location:
  • Phone: 907-580-2778
  • Fax: 907-580-6444
Mailing address:
  • Phone: 907-580-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1908
License Number StateNE

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: