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General NPI Number Information
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NPI Number | 1790740488
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Entity Type | Individual
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Provider Name | JOHN RICHARD COOK M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 1015 UNION ST STE 110
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City | BOONE
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State | IA
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Zip | 50036-4821
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Country | US
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Telephone | 515-433-8173
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Fax | 515-433-0696
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Provider Business Mailing Address
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Address Line | PO BOX 542
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City | BOONE
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State | IA
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Zip | 50036-0542
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Country | US
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Telephone | 515-433-8173
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Fax | 515-433-0696
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 19888
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License Number State | IA
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