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General NPI Number Information
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NPI Number | 1396741948
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Entity Type | Individual
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Provider Name | LORAN DAVIS COOK M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 1055 N 300 W STE 204
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City | PROVO
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State | UT
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Zip | 84604-3374
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Country | US
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Telephone | 801-357-7373
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Fax | 801-357-7217
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Provider Business Mailing Address
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Address Line | 1055 N 300 W
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City | PROVO
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State | UT
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Zip | 84604-3344
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Country | US
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Telephone |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 1550231205
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License Number State | UT
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