Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 36003231 | OH |
Y | 213ES0103X | Foot & Ankle Surgery | 36003231 | OH |
NPI | 1568577971 |
---|---|
Provider Name | Dr. Deborah Lynn Cook |
First Address | Cleveland, OH 44104-3869 |
Second Address | Cleveland, OH 44104-3869 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 30/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2246555 | (05) | OH |
4190543 | MEDICARE PTAN, INDIVIDUAL (01) | OH |
9384851 | MEDICARE PTAN, GROUP (01) | OH |
U85266 | (02) | OH |