Healthcare Provider Details

I. General information

NPI: 1245973601
Provider Name (Legal Business Name): MITCHELL ROBERT COOK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6370 W UNION HILLS DR
GLENDALE AZ
85308-7136
US

IV. Provider business mailing address

6370 W UNION HILLS DR
GLENDALE AZ
85308-7136
US

V. Phone/Fax

Practice location:
  • Phone: 623-414-3500
  • Fax:
Mailing address:
  • Phone: 623-414-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number012239
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: