Healthcare Provider Details

I. General information

NPI: 1417006560
Provider Name (Legal Business Name): DOUGLAS WESLEY COOK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 MAIN ST
WAILUKU HI
96793-1625
US

IV. Provider business mailing address

2180 MAIN ST
WAILUKU HI
96793-1625
US

V. Phone/Fax

Practice location:
  • Phone: 808-242-6464
  • Fax: 808-242-4233
Mailing address:
  • Phone: 808-242-6464
  • Fax: 808-242-4233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA98414
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD-17972
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: