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General NPI Number Information
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NPI Number | 1194720052
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Entity Type | Individual
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Provider Name | JACK T. COOK PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 06/24/2013
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Provider Practice Location Address
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Address Line | 250 PLEASANT STREET YEAPLE BUILDING
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City | CONCORD
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State | NH
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Zip | 03301-7539
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Country | US
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Telephone | 603-228-7200
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Fax | 603-228-7307
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Provider Business Mailing Address
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Address Line | 250 PLEASANT STREET YEAPLE BUILDING
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City | CONCORD
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State | NH
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Zip | 03301-7539
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Country | US
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Telephone | 603-228-7200
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Fax | 603-228-7307
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 432
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License Number State | NH
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