Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 2164Z | WI |
N | 207PE0004X | Emergency Medical Services | 2164Z | WI |
N | 207PP0204X | Pediatric Emergency Physician | 2164Z | WI |
Y | 207QA0505X | Family Doctor - Adult Medicine | 2164Z | WI |
NPI | 1790739712 |
---|---|
Provider Name | Dr. Steven D Cook |
First Address | Eau Claire, WI 54703-2593 |
Second Address | Altoona, WI 54720-1378 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 08/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000011010 | MEDICARE PTAN (01) | |
30188400 | (05) | WI |
553865300 | (05) | MN |
B52981 | (02) | WI |