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General NPI Number Information
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NPI Number | 1518353044
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Entity Type | Individual
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Provider Name | BRIAN COOK MD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2015
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Last Update Date | 03/27/2023
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Provider Practice Location Address
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Address Line | 5171 S COTTONWOOD ST STE 650
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City | SALT LAKE CITY
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State | UT
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Zip | 84107-5716
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Country | US
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Telephone | 916-505-6857
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Fax |
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Provider Business Mailing Address
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Address Line | 316 W 200 S APT 310
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City | SALT LAKE CITY
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State | UT
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Zip | 84101-1449
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Country | US
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Telephone | 801-507-9600
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Fax | 801-507-9601
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD.MD.61062859
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 13002841-1205
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License Number State | UT
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