Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 12407 | OR |
NPI | 1023103934 |
---|---|
Provider Name | Dr. James L Cook |
First Address | Portland, OR 97201-1604 |
Second Address | Portland, OR 97202-4525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 19/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C90859 | (02) | OR |