Healthcare Provider Details

I. General information

NPI: 1497989149
Provider Name (Legal Business Name): THOMAS LANNO COOK IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 UNIVERSITY AVE STE 302
HONOLULU HI
96826-1544
US

IV. Provider business mailing address

1110 UNIVERSITY AVE STE 302
HONOLULU HI
96826-1544
US

V. Phone/Fax

Practice location:
  • Phone: 808-457-1082
  • Fax: 808-356-1649
Mailing address:
  • Phone: 808-457-1082
  • Fax: 808-356-1649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: