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General NPI Number Information
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NPI Number | 1285636449
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Entity Type | Individual
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Provider Name | TERRY R COOK DPM
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Gender | Male
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 08/19/2019
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Provider Practice Location Address
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Address Line | 1478 EAST HWY 162
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City | MONTEZUMA CREEK
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State | UT
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Zip | 84534
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Country | US
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Telephone | 435-651-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 25543 ROAD N.6 LOOP
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City | CORTEZ
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State | CO
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Zip | 81321-8404
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Country | US
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Telephone | 970-565-8660
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Fax |
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 540
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 3406870501
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 540
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License Number State | CO
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