Healthcare Provider Details

I. General information

NPI: 1750002465
Provider Name (Legal Business Name): DAVID JOSEPH COOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 08/28/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ECCLES INSTITUTE OF HUMAN GENETICS: 15 N MEDICAL DR RM
SALT LAKE CITY UT
84112
US

IV. Provider business mailing address

ECCLES INSTITUTE OF HUMAN GENETICS: 15 N MEDICAL DR RM
SALT LAKE CITY UT
84112
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2121
  • Fax:
Mailing address:
  • Phone: 801-581-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number14235906-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number32870
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number74855
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: