Healthcare Provider Details

I. General information

NPI: 1952799264
Provider Name (Legal Business Name): JAMES R. COOK, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 E GLENWOOD ST
SPRINGFIELD MO
65804-3320
US

IV. Provider business mailing address

2333 E GLENWOOD ST
SPRINGFIELD MO
65804-3320
US

V. Phone/Fax

Practice location:
  • Phone: 417-883-3963
  • Fax:
Mailing address:
  • Phone: 417-883-3963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number29093
License Number StateMO

VIII. Authorized Official

Name: JAMES ROBERT COOK
Title or Position: PRACTIONER
Credential: MD
Phone: 417-883-3963