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NPI Code Detail

MEDICARE: THOMAS R COOK III D.M.D, M.D

MEDICARE: THOMAS R COOK III D.M.D, M.D
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
11223S0112XOral and Maxillofacial Surgery (Dentist)DS0000004615TN
21223S0112XOral and Maxillofacial Surgery (Dentist)DS04615GA

General Provider Information

NPI Number : 1265564660
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS R COOK III D.M.D, M.D
Provider Business Mailing Address
First Line : 110 N PALISADES DR
Second Line :
City : SIGNAL MOUNTAIN
State : TN
Zip : 37377-3037
Country : US
Telephone Number : 423-886-9337
Fax Number : 423-899-9182
Provider Business Practice Location Address
First Line : 625 MORRISON SPRINGS RD
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37415-3401
Country : US
Telephone Number : 423-855-5550
Fax Number : 423-899-9182
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2007
Last Update Date : 07/08/2007

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