Healthcare Provider Details

I. General information

NPI: 1750487609
Provider Name (Legal Business Name): LORAN D COOK MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N 300 W STE 204
PROVO UT
84604-3374
US

IV. Provider business mailing address

1055 N 300 W STE 204
PROVO UT
84604-3374
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-7373
  • Fax: 801-357-7217
Mailing address:
  • Phone: 801-357-7373
  • Fax: 801-357-7217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number921109409934
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number465810019
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number49624391205
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0767410010
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number9018279011205
License Number StateUT
# 6
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number931131489934
License Number StateUT

VIII. Authorized Official

Name: DR. LORAN DAVIS COOK
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 801-357-7373