Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 12009951 | IN |
NPI | 1205998739 |
---|---|
Provider Name | Dr. John Craig Cook |
First Address | New Albany, IN 47150 |
Second Address | New Albany, IN 47150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000250731 | ANTHEM (01) | |
1309407 | UNITED CONCORDIA (01) | |
U87251 | (02) |