MEDICARE: DR. DANIEL JAMES 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	207L00000X	Anesthesiology Physician	R5G83	MO

General Provider Information

NPI Number	:	1891053229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL JAMES COOK M.D.

Provider Business Mailing Address
First Line	:	1101 LUCAS AVE STE 200
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63101-1159
Country	:	US
Telephone Number	:	314-781-5700
Fax Number	:	314-644-4262

Provider Business Practice Location Address
First Line	:	1101 LUCAS AVE STE 200
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63101-1159
Country	:	US
Telephone Number	:	314-781-5700
Fax Number	:	314-644-4262

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

Provider Enumeration Date	:	04/23/2012
Last Update Date	:	04/23/2012

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