Healthcare Provider Details

I. General information

NPI: 1003235110
Provider Name (Legal Business Name): KIRI ANN COOK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 N BROADWAY
PORTLAND OR
97227-1800
US

IV. Provider business mailing address

1498 SE TECH CENTER PL STE 240
VANCOUVER WA
98683-5508
US

V. Phone/Fax

Practice location:
  • Phone: 503-280-1223
  • Fax:
Mailing address:
  • Phone: 360-597-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD194095
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: