MEDICARE: DR. LAUREL B COOK I DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0131X	Foot Surgery Podiatrist	641	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073500823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREL B COOK I DPM

Provider Business Mailing Address
First Line	:	709 E MEADECREST DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-2441
Country	:	US
Telephone Number	:	865-981-4595
Fax Number	:	865-981-4544

Provider Business Practice Location Address
First Line	:	603 SMITHVIEW DR
Second Line	:
City	:	MARYVILLE
State	:	TN
Zip	:	37803-6100
Country	:	US
Telephone Number	:	865-981-4595
Fax Number	:	865-981-4544

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	10/08/2010

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