Healthcare Provider Details

I. General information

NPI: 1881399426
Provider Name (Legal Business Name): COOK CHILDREN'S PHYSICIAN NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 24TH STREET STE 401
LUBBOCK TX
79410
US

IV. Provider business mailing address

PO BOX 733784
DALLAS TX
75373-3784
US

V. Phone/Fax

Practice location:
  • Phone: 806-795-1801
  • Fax: 806-795-1373
Mailing address:
  • Phone: 682-885-6483
  • Fax: 682-303-7132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW V DZURIK
Title or Position: PRESIDENT
Credential: MD
Phone: 682-885-6122