Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | G63727 | CA |
NPI | 1013078427 |
---|---|
Provider Name | Glenn Cook |
First Address | La Mesa, CA 91942-2000 |
Second Address | La Mesa, CA 91942-2000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 19/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G637271 | (05) | CA |
0802380001 | NORIDIAN PROVIDER NUMBER (01) | CA |
0802380003 | CORONADO OFFICE NORIDIAN (01) | CA |
E98328 | (02) |