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1992579262 NPI number — TRAVIS ALAN COOK

NPI Number: 1992579262
Health Care Provider/Practitioner: TRAVIS ALAN COOK

Information about “1992579262” NPI (TRAVIS ALAN COOK) exists in 1992579262 in HTML format HTML  |  1992579262 in plain Text format TXT  |  1992579262 in PDF (Portable Document Format) PDF  |  1992579262 in an XML format XML  formats.

NPI Number : 1992579262 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1992579262",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COOK",
    "FirstName": "TRAVIS",
    "MiddleName": "ALAN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "204 EGRET POINT DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SNEADS FERRY",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28460-9464",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "956-279-0404",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1ST MAR RDR BN MRR MARFORSOC",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CAMP LEJEUNE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28542",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "910-440-3136",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/08/2023",
    "LastUpdateDate": "11/08/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "171000000X",
        "TaxonomyName": "Military Health Care Provider",
        "LicenseNumber": "07222805TC",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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