Healthcare Provider Details

I. General information

NPI: 1740254192
Provider Name (Legal Business Name): RANDOLPH BRYANT COOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 FAIR OAKS AVE STE 100
ARROYO GRANDE CA
93420-3929
US

IV. Provider business mailing address

850 FAIR OAKS AVE STE 100
ARROYO GRANDE CA
93420-3929
US

V. Phone/Fax

Practice location:
  • Phone: 805-473-0700
  • Fax: 805-473-5931
Mailing address:
  • Phone: 805-473-0700
  • Fax: 805-473-5931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG89412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: