Healthcare Provider Details

I. General information

NPI: 1255617072
Provider Name (Legal Business Name): COOK FOOT & ANKLE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 N 2000 W
FARR WEST UT
84404-9219
US

IV. Provider business mailing address

550 E 1400 N #B
LOGAN UT
84341-2406
US

V. Phone/Fax

Practice location:
  • Phone: 435-752-9011
  • Fax: 435-752-7159
Mailing address:
  • Phone: 435-752-9011
  • Fax: 435-752-7159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number72759630501
License Number StateUT

VIII. Authorized Official

Name: KATHY WRIGHT
Title or Position: OFFICE MANAGER
Credential:
Phone: 435-752-9011