Healthcare Provider Details

I. General information

NPI: 1578567533
Provider Name (Legal Business Name): TIMOTHY H COOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 NW 56TH ST STE 400
OKLAHOMA CITY OK
73112-4430
US

IV. Provider business mailing address

3433 NW 56TH ST STE 400
OKLAHOMA CITY OK
73112-4430
US

V. Phone/Fax

Practice location:
  • Phone: 405-917-3518
  • Fax: 405-951-4361
Mailing address:
  • Phone: 405-917-3518
  • Fax: 405-951-4361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21344
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number21344
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: