=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619104346
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRAZORIA COUNTY OBSTETRICS AND GYNECOLOGY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2009
-----------------------------------------------------
Last Update Date | 07/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 146 E HOSPITAL DR 208
-----------------------------------------------------
City | ANGLETON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77515-4169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-849-5940
-----------------------------------------------------
Fax | 979-849-5944
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 146 E HOSPITAL DR 208
-----------------------------------------------------
City | ANGLETON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77515-4169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-849-5940
-----------------------------------------------------
Fax | 979-849-5944
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GREGORY C COOKE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 979-849-5940
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------