Healthcare Provider Details

I. General information

NPI: 1417166489
Provider Name (Legal Business Name): JOEL M. COOK, DPM, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5677 S REX RD
MEMPHIS TN
38119-3821
US

IV. Provider business mailing address

5677 S REX RD
MEMPHIS TN
38119-3821
US

V. Phone/Fax

Practice location:
  • Phone: 901-818-2727
  • Fax: 901-818-2737
Mailing address:
  • Phone: 901-818-2727
  • Fax: 901-818-2737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDPM0000000119
License Number StateTN

VIII. Authorized Official

Name: DR. JOEL MARTIN COOK
Title or Position: OWNER
Credential: D.P.M.
Phone: 901-818-2727