Healthcare Provider Details

I. General information

NPI: 1871576520
Provider Name (Legal Business Name): JAY F. COOK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 EDISON ST
BRUSH CO
80723-1640
US

IV. Provider business mailing address

5530 E 6TH AVENUE PKWY
DENVER CO
80220-5244
US

V. Phone/Fax

Practice location:
  • Phone: 970-842-6256
  • Fax:
Mailing address:
  • Phone: 303-333-7552
  • Fax: 303-388-8304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number29566
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: