=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063827335
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN LEE COOK DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2014
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 HEARTLAND RD STE 3800
-----------------------------------------------------
City | SAINT JOSEPH
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64506-6201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-671-4800
-----------------------------------------------------
Fax | 816-279-0421
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 HEARTLAND RD STE 3800
-----------------------------------------------------
City | SAINT JOSEPH
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64506-6202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-671-4800
-----------------------------------------------------
Fax | 816-279-0421
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | DO-04770
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 2017022377
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------