Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 2015003727 | MO |
NPI | 1215046388 |
---|---|
Provider Name | Jonathan Foster Cook |
First Address | Springfield, MO 65808-9007 |
Second Address | Springfield, MO 65807-7310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 27/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1215046388 | (05) | MO |
200020165 | (05) | MO |