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NPI Code Detail

MEDICARE: DR. JERED M. COOK M.D.

MEDICARE: DR. JERED M. 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
1207RC0000XCardiovascular Disease Physician34453OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558619338
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JERED M. COOK M.D.
Provider Business Mailing Address
First Line : 3433 NW 56TH ST STE 400
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73112-4430
Country : US
Telephone Number : 405-947-3341
Fax Number : 405-917-3590
Provider Business Practice Location Address
First Line : 3433 NW 56TH ST STE 660
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73112-4449
Country : US
Telephone Number : 405-947-3341
Fax Number : 405-917-3590
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2012
Last Update Date : 11/19/2019

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