MEDICARE: DR. BRET ALAN COOK MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	MD22262	OR
2	207RX0202X	Medical Oncology Physician	MD22262	OR

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	CB3544	OTHER	OR	RR MEDICARE GROUP NUMBER
6	P00143366	OTHER	OR	RR MEDICARE PTAN NUMBER

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1407812365	OTHER	OR	NBMC NPI NUMBER-GROUP
2	930635514	OTHER	OR	GROUP TAX ID
3	R0000WFBTV	OTHER	OR	GROUP PIN NUMBER
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MD22262	OTHER	OR	MEDICAL LICENSE OREGON

NPI Number	:	1184608994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRET ALAN COOK MD

Provider Business Mailing Address
First Line	:	1900 WOODLAND DR
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-0000
Country	:	US
Telephone Number	:	541-267-5151
Fax Number	:	541-267-3800

Provider Business Practice Location Address
First Line	:	1900 WOODLAND DR
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-0000
Country	:	US
Telephone Number	:	541-267-5151
Fax Number	:	541-267-3800

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	05/20/2013

1900 WOODLAND DRIVE
COOS BAY, OR
97420-0000

Practice Phone: 541-267-5151
Practice Fax: 541-266-4553