Healthcare Provider Details

I. General information

NPI: 1093738726
Provider Name (Legal Business Name): LOREN NICHOLS COOK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4528 CHAPMAN HWY
KNOXVILLE TN
37920-4359
US

IV. Provider business mailing address

4528 CHAPMAN HWY
KNOXVILLE TN
37920-4359
US

V. Phone/Fax

Practice location:
  • Phone: 865-579-3920
  • Fax: 865-579-3963
Mailing address:
  • Phone: 865-579-3920
  • Fax: 865-579-3963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD24518
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: