Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 01019042A | IN |
Y | 208600000X | Surgeon | 01019042A | IN |
NPI | 1023030285 |
---|---|
Provider Name | Dr. Ian H. Cook |
First Address | Fort Wayne, IN 46804-6702 |
Second Address | Fort Wayne, IN 46805-5100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B28137 | (02) | IN |