MEDICARE: DR. LAWRENCE J. COOK 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
1	207RC0000X	Cardiovascular Disease Physician	31631	AZ

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
2	AZ0734280	OTHER	AZ	BCBS

General Provider Information

NPI Number	:	1366442162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE J. COOK M.D.

Provider Business Mailing Address
First Line	:	3016 E ROBIN LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-8422
Country	:	US
Telephone Number	:	480-734-6088
Fax Number	:

Provider Business Practice Location Address
First Line	:	3016 E ROBIN LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-8422
Country	:	US
Telephone Number	:	480-734-6088
Fax Number	:

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	05/16/2022

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