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General NPI Number Information
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NPI Number | 1083697965
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Entity Type | Individual
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Provider Name | FREDERICK G COOK MD
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Gender | Male
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 5050 SKYLINE VILLAGE LOOP S
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City | SALEM
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State | OR
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Zip | 97306-9490
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Country | US
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Telephone | 503-391-1110
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Fax | 503-370-4237
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Provider Business Mailing Address
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Address Line | 1015 3RD ST NW
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City | SALEM
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State | OR
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Zip | 97304-4007
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Country | US
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Telephone | 503-588-3600
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Fax | 503-363-3891
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD12674
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License Number State | OR
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