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General NPI Number Information
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NPI Number | 1932070331
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Entity Type | Organization
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Legal Business Name | COOK CLINIC LLC
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 10462 S REDWOOD RD
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-8501
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Country | US
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Telephone | 801-606-4307
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Fax | 801-606-4315
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Provider Business Mailing Address
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Address Line | 63 E 11400 S # 307
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City | SANDY
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State | UT
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Zip | 84070-6705
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Country | US
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Telephone | 801-606-4307
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Fax | 801-606-4315
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | DR. DAVID COOK
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Credential | MD
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Telephone | 217-791-3670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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